Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 26, 2020; 8(20): 4816-4825
Published online Oct 26, 2020. doi: 10.12998/wjcc.v8.i20.4816
Intraoperative systemic vascular resistance is associated with postoperative nausea and vomiting after laparoscopic hysterectomy
Meng-Di Qu, Meng-Yuan Zhang, Gong-Ming Wang, Zhun Wang, Xu Wang
Meng-Di Qu, Meng-Yuan Zhang, Gong-Ming Wang, Zhun Wang, Xu Wang, Department of Anesthesiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
Author contributions: Qu MD and Zhang MY contributed to all aspects of this manuscript, including study conception and design, collection and analysis of data, drafting and revising this manuscript; Wang GM contributed to the study conception and design, and drafting this manuscript; Wang Z contributed to the collection and analysis of data; Wang X was involved in drafting the manuscript and revising it for important intellectual content; all authors read and approved the final manuscript.
Institutional review board statement: The study was approved by the Ethics Committee of Shandong Provincial Hospital Affiliated to Shandong First Medical University (NO.2018-052).
Informed consent statement: Both verbal and written informed consents were obtained from patients before surgery.
Conflict-of-interest statement: The authors of this manuscript have no conflicts of interest to disclose.
Data sharing statement: There are no additional data available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the statement checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Xu Wang, PhD, Attending Doctor, Department of Anesthesiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Road, Jinan 250021, Shandong Province, China. cityhunter54@163.com
Received: July 21, 2020
Peer-review started: July 21, 2020
First decision: August 7, 2020
Revised: August 11, 2020
Accepted: September 2, 2020
Article in press: September 2, 2020
Published online: October 26, 2020
Processing time: 94 Days and 3.1 Hours
Abstract
BACKGROUND

The incidence of postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic hysterectomy is very high compared with other surgeries, even when many prophylactic measures have been taken. However, the pathogenesis of PONV is multifactorial. Female sex, a history of motion sickness or PONV, nonsmokers, and perioperative opioid use are the most closely related factors. Among the multiple risk factors, suboptimal gastrointestinal (GI) perfusion may be attributed to some cases of PONV, and increased systemic vascular resistance (SVR) may lead to GI ischemia. The hypothesis of this research was that SVR is related to PONV.

AIM

To investigate the relationship between SVR and PONV in patients undergoing laparoscopic hysterectomy.

METHODS

A total of 228 patients who underwent elective laparoscopic hysterectomy were included in this prospective observational study. SVR was monitored using a noninvasive hemodynamic monitoring system. Four indices of SVR, the baseline, mean, area under the curve (AUC), and weighted AUC, were used for analysis. The incidence and severity of nausea and vomiting were evaluated while patients were awake and throughout the intervals from 0 to 2 h, 2 to 6 h, and 6 to 24 h starting upon arrival at the post-anesthesia care unit. The associations between various SVR indices and PONV were investigated by logistic regression. P < 0.05 was considered statistically significant.

RESULTS

The incidence of PONV in the study was 56.14% (128/228), and PONV tended to appear within 6 h after surgery. Five variables were significant in univariate analyses, however, only SVR mean [odds ratio (OR) = 1.015, 95%CI: 1.005-1.109, P = 0.047] and duration of surgery (OR = 1.316, 95%CI: 1.003-2.030, P = 0.012) were associated with PONV after logistic regression analysis. Furthermore, patients with high SVR mean were more likely to suffer from PONV after laparoscopic hysterectomy. On average, patients who developed PONV needed more time to tolerate diet and demonstrated poorer sleep quality on the first night after surgery.

CONCLUSION

In this study, PONV was a common complication after laparoscopic hysterectomy. SVR was associated with PONV, and high SVR mean was associated with a significantly increased risk of PONV.

Keywords: Postoperative nausea and vomiting; Systemic vascular resistance; Gastrointestinal perfusion; Laparoscopic hysterectomy; Prospective observational study; Pneumoperitoneum

Core Tip: We performed a prospective observational study of the risk factors for postoperative nausea and vomiting (PONV) after laparoscopic hysterectomy in a single institution. We analyzed the relationship between systemic vascular resistance (SVR) indices and the occurrence of PONV and found that higher SVR mean was associated with increased risk of PONV after laparoscopic hysterectomy.