The effect of crystalloid versus medium molecular weight colloid solution on post-operative nausea and vomiting after ambulatory gynecological surgery - a prospective randomized trial

Abstract

BackgroundIntravenous fluid is recommended in international guidelines to improve patient post-operative symptoms, particularly nausea and vomiting. The optimum fluid regimen has not been established. This prospective, randomized, blinded study was designed to determine if administration of equivolumes of a colloid (hydroxyethyl starch 130/0.4) reduced post operative nausea and vomiting in healthy volunteers undergoing ambulatory gynecologic laparoscopy surgery compared to a crystalloid solution (Hartmann’s Solution).Methods120 patients were randomized to receive intravenous colloid (N = 60) or crystalloid (N = 60) intra-operatively. The volume of fluid administered was calculated at 1.5 ml.kg-1 per hour of fasting. Patients were interviewed to assess nausea, vomiting, anti-emetic use, dizziness, sore throat, headache and subjective general well being at 30 minutes and 2, 24 and 48 hours post operatively. Pulmonary function testing was performed on a subgroup.ResultsAt 2 hours the proportion of patients experiencing nausea (38.2 % vs 17.9%, P = 0.03) and the mean nausea score were increased in the colloid compared to crystalloid group respectively (1.49 ± 0.3 vs 0.68 ± 0.2, P = 0.028). The incidence of vomiting and anti-emetic usage was low and did not differ between the groups. Sore throat, dizziness, headache and general well being were not different between the groups. A comparable reduction on post-operative FVC and FEV-1 and PEFR was observed in both groups.ConclusionsIntra-operative administration of colloid increased the incidence of early postoperative nausea and has no advantage over crystalloid for symptom control after gynaecological laparoscopic surgery.

Is perioperative colloid infusion more effective than crystalloid in preventing postoperative nausea and vomiting?

“…In all 3 studies with anesthesia duration longer than 3 hours, interventional fluids were administered intraoperatively. On the other hand, among studies with anesthesia duration <3 hours, intervention was performed before induction of anesthesia in 4 studies, and intraoperatively in only one study (by Hayes et al [16] ).…”

“…Four studies [13,15–16,19] only included female patients, whereas another 4 studies [6,14,17–18] included both male and female patients. One study by Ghodraty et al [14] was performed under total intravenous anesthesia using propofol, whereas all other studies used inhalation anesthetics.…”

“…One study by Ghodraty et al [14] was performed under total intravenous anesthesia using propofol, whereas all other studies used inhalation anesthetics. Nitrous oxide and air were used in 3 [13,18–19] and 4 studies, [6,14–16] respectively. Patients in 2 studies [16,19] received postoperative opioids when needed, but patients in 4 studies [6,13–15] did not receive it.…”

“…Nitrous oxide and air were used in 3 [13,18–19] and 4 studies, [6,14–16] respectively. Patients in 2 studies [16,19] received postoperative opioids when needed, but patients in 4 studies [6,13–15] did not receive it. The studies by Chaudhary et al [13] and Turkistani et al [6] only included patients without history of smoking, motion sickness, and previous PONV, and 4 studies [6,13,15,19] only included patients who did not receive prophylactic antiemetics.…”

Ambulatory anesthesia and postoperative nausea and vomiting: predicting the probability

“…71,72 The results of the studies investigating colloids are conflicting. 73 Preoperative oral carbohydrate drinks taken 2 hours preoperatively have been shown to reduce PONV. 74 Acustimulation A recent Cochrane review assessed the literature regarding stimulation of the wrist acupuncture point PC6 for preventing PONV and found the technique to be noninferior to pharmacological antiemetics.…”