Abstract | BACKGROUND: METHODS: Patients undergoing gynecologic laparoscopic surgery were randomized to receive 30% oxygen with air (G0, n = 46), 50% N(2)O with oxygen (G50, n = 46), or 70% N(2)O with oxygen (G70, n = 45). A standardized general anesthetic was used with no PONV prophylaxis. Known risk factors for PONV were controlled. Metoclopramide was used as a rescue antiemetic. The incidence of nausea, vomiting, use of rescue antiemetic, and pain visual analog scale (VAS) score was measured at 2 and 24 h postoperatively. RESULTS: Patient demographics were comparable, and there were no differences among groups regarding factors that may influence PONV. The incidence of PONV at 24 h was 33% (15 of 46) in the G0 group, 46% (21 of 46) in the G50 group, and 62% (28 of 45) in the G70 group (P = 0.018). Subgroup analysis revealed a difference between G0 versus G70 groups (P = 0.018), but no significant difference between G0 versus G50 groups and G50 versus G70 groups. The incidence of nausea showed a similar difference (G0 = 26%, G50 = 35%, and G70 = 56%; P = 0.012), but the incidence of vomiting was not different among the groups although there was a trend (G0 = 28%, G50 = 35%, and G70 = 42%; P = 0.377). The severity of nausea (measured by VAS 100 mm) was significantly increased with increasing N(2)O concentration (G0 = 10.9, G50 = 12.7, and G70 = 20.5; P = 0.027). The highest VAS score during 24 h was used for the analysis. There was no difference in the use of a rescue antiemetic among groups. Pain VAS scores and opioids consumption were not different among groups (at 2 and 24 h after surgery). CONCLUSIONS: N(2)O increases the incidence of postoperative nausea after gynecologic laparoscopic surgery. This preliminary finding indicates that N(2)O may increase PONV in a dose-dependent fashion. A study with a sample size of >400 patients in each group would be necessary to demonstrate a statistically significant difference among each of these three groups. We do not recommend using a high concentration of N(2)O in this clinical setting.
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Authors | Boris Mraovic, Tatjana Simurina, Zdenko Sonicki, Neven Skitarelic, Tong J Gan |
Journal | Anesthesia and analgesia
(Anesth Analg)
Vol. 107
Issue 3
Pg. 818-23
(Sep 2008)
ISSN: 1526-7598 [Electronic] United States |
PMID | 18713890
(Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
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Chemical References |
- Nitrous Oxide
- Metoclopramide
- Oxygen
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Topics |
- Adult
- Aged
- Anesthesia
(methods)
- Dose-Response Relationship, Drug
- Female
- Gynecologic Surgical Procedures
(methods)
- Humans
- Laparoscopy
(methods)
- Metoclopramide
(pharmacology)
- Middle Aged
- Nitrous Oxide
(pharmacology)
- Oxygen
(metabolism)
- Pain
(drug therapy, prevention & control)
- Postoperative Nausea and Vomiting
(drug therapy, prevention & control)
- Postoperative Period
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