当前位置: X-MOL 学术Curr. Med. Res. Opin. › 论文详情
Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)
Isoflurane not at the expense of postoperative nausea and vomiting in cardiac anesthesia – an observational study
Current Medical Research and Opinion ( IF 2.3 ) Pub Date : 2021-10-01 , DOI: 10.1080/03007995.2021.1980776
Christine H Meyer-Frießem 1 , Sabeth Hüsken 1 , Miriam Kaisler 1 , Nathalie M Malewicz 1 , Peter K Zahn 1 , Andreas Baumann 1
Affiliation  

Abstract

Objectives

Inhalative anesthesia is of common use, but is generally known to potentiate postoperative nausea and vomiting (PONV). With an internal change of anesthesia regimen from total intravenous anesthesia (TIVA) to isoflurane (in terms of myocardial protection) in cardiac anesthesia a higher incidence of PONV was to be expected. Therefore, we evaluated the incidence of PONV after the simultaneous implementation of PONV prophylaxis.

Methods

The incidence of PONV, prospectively assessed in 197 cardiac surgery patients (68 y ± 10.4, 66.5% male) having isoflurane plus dual PONV prophylaxis with dexamethasone and droperidol, was compared with previous data of 190 controls (67 y ± 9.6, 71% male) having TIVA without and with single or dual PONV prophylaxis (n = 64 dexamethasone and droperidol, n = 25 dexamethasone, n = 101 only TIVA), and the Apfel-scoring (0–4 depending on PONV-risk). DRKS00014275. Statistics: Chi2-test, p < .05 (Bonferroni).

Results

The incidence of PONV under isoflurane with antiemetic prophylaxis was 20.8% (95% confidence interval (CI) 15.4; 27.4) compared to 30.5% (95%CI 24; 37.6) under TIVA (p = .029; dexamethasone and droperidol 23.4% (95%CI 13.8; 35.7); dexamethasone 32% (95%CI 14.9; 53.5); only TIVA 34.7% (95%CI 25.5; 44.8)), but was not lower in high-risk patients than predicted according to Apfel-scoring 4 (71.4 vs. 78%).

Conclusion

In cardiac anesthesia, the use of isoflurane is not at the expense of PONV when using a risk-independent two-drug-prophylaxis. It is even beneficial resulting surprisingly in a lower incidence of PONV than under TIVA unless with and without prophylaxis. Patients with the highest risk for PONV and receiving isoflurane should receive a third antiemetic prophylactic drug.



中文翻译:

异氟醚不以心脏麻醉术后恶心和呕吐为代价——一项观察性研究

摘要

目标

吸入麻醉是常用的,但通常已知会增强术后恶心和呕吐 (PONV)。随着心脏麻醉中麻醉方案从全静脉麻醉 (TIVA) 到异氟醚(在心肌保护方面)的内部变化,预计会增加 PONV 的发生率。因此,我们评估了同时实施 PONV 预防后 PONV 的发生率。

方法

将 197 名接受异氟醚加地塞米松和氟哌利多双重预防性 PONV 的心脏手术患者(68 岁 ± 10.4,66.5 % 男性)前瞻性评估的 PONV 发生率  与 190 名对照(67 岁  ± 9.6,71 % 男性)的先前数据进行了比较) 有 TIVA,没有和有单一或双重 PONV 预防(n  = 64 地塞米松和氟哌利多,n  = 25 地塞米松,n  = 101 仅 TIVA)和 Apfel 评分(0-4,取决于 PONV 风险)。DRKS00014275。统计数据:Chi 2检验,p  < .05 (Bonferroni)。

结果

异氟醚预防性止吐的 PONV 发生率为 20.8%(95% 置信区间 (CI) 15.4;27.4),而 TIVA 组为 30.5%(95%CI 24;37.6)(p  = .029;地塞米松和氟哌利多为 23.4%( 95%CI 13.8; 35.7);地塞米松 32% (95%CI 14.9; 53.5);仅 TIVA 34.7% (95%CI 25.5; 44.8)),但在高危患者中并不低于根据 Apfel 评分预测的值4(71.4 对 78%)。

结论

在心脏麻醉中,当使用与风险无关的双药预防时,异氟醚的使用不会以 PONV 为代价。与 TIVA 相比,它甚至令人惊讶地导致 PONV 的发生率更低,除非有或没有预防措施。PONV 风险最高且接受异氟醚治疗的患者应接受第三种预防性止吐药。

更新日期:2021-12-01
down
wechat
bug