Muscular Tissue Oxygen Saturation and Posthysterectomy Nausea and Vomiting

恶心 医学 呕吐 麻醉 氧饱和度 术后恶心呕吐 前臂 随机对照试验 外科 氧气 有机化学 化学
作者
Gang Li,Dandan Tian,Xu Wang,Xiaoxian Feng,Wenyu Zhang,Ju Bao,Dong‐Xin Wang,Yanqiu Ai,Ya Liu,Mengyuan Zhang,Mingjun Xu,Dezhi Mu,Xu Zhao,Feng Dai,Jianjun Yang,Xiangming Che,David Yanez,Xiang-yang Guo,Lingzhong Meng
出处
期刊:Anesthesiology [Ovid Technologies (Wolters Kluwer)]
卷期号:133 (2): 318-331 被引量:10
标识
DOI:10.1097/aln.0000000000003305
摘要

Suboptimal tissue perfusion and oxygenation during surgery may be responsible for postoperative nausea and vomiting in some patients. This trial tested the hypothesis that muscular tissue oxygen saturation-guided intraoperative care reduces postoperative nausea and vomiting.This multicenter, pragmatic, patient- and assessor-blinded randomized controlled (1:1 ratio) trial was conducted from September 2018 to June 2019 at six teaching hospitals in four different cities in China. Nonsmoking women, 18 to 65 yr old, and having elective laparoscopic surgery involving hysterectomy (n = 800) were randomly assigned to receive either intraoperative muscular tissue oxygen saturation-guided care or usual care. The goal was to maintain muscular tissue oxygen saturation, measured at flank and on forearm, greater than baseline or 70%, whichever was higher. The primary outcome was 24-h postoperative nausea and vomiting. Secondary outcomes included nausea severity, quality of recovery, and 30-day morbidity and mortality.Of the 800 randomized patients (median age, 50 yr [range, 27 to 65]), 799 were assessed for the primary outcome. The below-goal muscular tissue oxygen saturation area under the curve was significantly smaller in patients receiving muscular tissue oxygen saturation-guided care (n = 400) than in those receiving usual care (n = 399; flank, 50 vs. 140% · min, P < 0.001; forearm, 53 vs. 245% · min, P < 0.001). The incidences of 24-h postoperative nausea and vomiting were 32% (127 of 400) in the muscular tissue oxygen saturation-guided care group and 36% (142 of 399) in the usual care group, which were not significantly different (risk ratio, 0.89; 95% CI, 0.73 to 1.08; P = 0.251). There were no significant between-group differences for secondary outcomes. No harm was observed throughout the study.In a relatively young and healthy female patient population, personalized, goal-directed, muscular tissue oxygen saturation-guided intraoperative care is effective in treating decreased muscular tissue oxygen saturation but does not reduce the incidence of 24-h posthysterectomy nausea and vomiting.
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