Hatice TÜRE, Arzu TAKIL, Zeynep ETİ, F. Yılmaz GÖĞÜŞ

The effect of nitrous oxide to postoperative nausea-vomiting

Amaç:Postoperatif bulantı ve kusma (POBK) birçok nedenden kaynaklanan ve sık karşılaşılan bir problemdir. POBK ve nitröz oksit arasındaki ilişi yeterince araştırılmıştır.Bu çalışmada laparoskopik kolesistektomi geçiren hastalarda, nitröz oksitin POBK`ya etkisinin araştırılması amaçlanmıştır. Yöntem: Premedikasyon yapılmış, ASA I-II, 18-60 yas arasında, 50-80 kg ağırlığında, elektif laparoskopik kolesistektomi operasyonu geçirecek 40 kadın hasta çalışmaya dahil edildi. Hastalar randomize olarak 2 gruba ayrıldı. Tüm hastalara tiyopental sodyum, remifentanil ve atrakuryum ile anestezi indüksiyonu uygulandı. Anestezi idamesinde, grup I`de sevofluran ve nitröz oksit-oksijen karışımı,grup II`de sevofluran ve hava-oksijen karışımı kullanıldı. Tüm hastalara peroperatif remifentanil infüzyonu verildi. Hastaların POBK ve ağrı skorları 24 saat süre ile takip edildi. Bulgular: POBK skorları, grup I`de 1. ve 4. saatlerde diğer saatlere göre yüksekti, ancak grup II`de saatler arasinda istatistiksel fark saptanmadı. Gruplar arasında, POBK ve ağrı skorları, antiemetik ilaç ihtiyacı olan hasta yüzdesi açısından fark saptanmadı. Hastaların POBK ve ağrı skorları arasında ilişki saptanmadı. Sonuç: Çalışmamız sonucunda, laparoskopik kolesistektomi operasyonu geçiren hastalarda, peroperatif kullanılan nitröz oksidin, postoperatif bulantı ve kusmanın sıklığı ve şiddetini arttırmadığı sonucuna varılmıştır.

Nitröz oksidin postoperatif bulantı-kusma üzerine etkisi

Objective:Postoperative nausea and vomiting (PONV) is a common problem and it’s cause is multifactorial. The relationship between PONV and nitrous oxide is under debate. The aim of this study was to evaluate the relationship between nitrous oxide and PONV in patients undergoing laparoscopic cholecystectomy. Patients and Methods: Forty premedicated female patients, ASA I or II, age 18-60 years and weighing between 50-80 kg, were scheduled to undergo elective laparoscopic cholecystectomy. They were randomly assigned to two groups. Anaesthesia was induced in all patients with thiopental sodium, remifentanil and atracurium. Anaesthesia was maintained with sevoflurane, nitrous oxide in oxygen in group I and sevoflurane, air in oxygen in group II. Perioperatively remifentanil was infused in all patients. The patient’s PONV and pain scores were assessed 24 hours postoperatively. Results: In group I, PONV scores were significantly higher at 1st and 4 th h postoperatively, however, there was no significant difference in group II. There was no significant difference in PONV and pain scores and the percentage of patients needing antiemetics between groups. No correlation was found between PONV and postoperative pain. Conclusion: Our data demonstrate that nitrous oxide does not increase the incidence or severity of PONV in patients undergoing laparoscopic cholecystectomy.

PDF

___

1) Fisher DM. The “big little problem” of postoperative nausea and vomiting; do we know the answer yet (editorial)? Anesthesiology 1997; 87: 1271-5.
2) Kapur PA. The big “little problem”. Anesth Analg 1991; 73: 243-5.
3) Alexander GD, Skupski JN, Brown EM. The role of nitrous oxide in postoperative nausea and vomiting. Anest Analg 1984; 63: 17S.
4) Korttila K. The study of postoperative nausea and vomiting. Br J Anaesth 1992; 69 (suppl): 20S-23S.
5) Watcha MF, Postoperative nausea and emesis. Anesthesiology Clinics of North America 2002; 20: 471-84.
6) Pandit UA, Malviya S, Lewis IH. Vomiting after outpatient tonsillectomy and adenoidectomy in children: the role of nitrous oxide. Anesth Analg 1995; 80: 230-3.
7) Alexander GD, Skupski JN, Brown EM. The role of nitrous oxide in postoperative nausea and vomiting. Anesth Analg 1984; 63: 17S.
8) Lonie DS, Harper NJN: Nitrous oxide and vomiting. The effect of nitrous oxide on the incidence of vomiting following gynecological laparoscopy. Anaesthesia 1986; 141: 703-7.
9) Felts JA, Poler M, Spitznagel EL. Nitrous oxide, nausea and vomiting after outpatient gynecologic surgery. J Clin Anesth 1990; 2: 168-171.
10) Andrews PLR. Physiology of nausea and vomiting. Br J Anaesth 1992; 69 (suppl 1): 2S-19S.
11) Junger A, Hartmann B, Benson M et al. The use of an anaesthesia information management system for prediction of antiemetic rescue treatment at the postanesthesia care unit. Anesth Analg 2001; 92: 1203-9.
12) Tramer MR. A rational approach to the control of postoperative nausea and vomiting: evidence from systematic reviews. Part I. Efficacy and harm of antiemetic interventions, and methodological issues. Acta Anaesthesiol Scand 2001; 45: 4-13.
13) Sinclair DR, Chung F, Mezei G. can postoperative nausea and vomiting be predicted? Anesthesiology 1999; 91: 109-18.
14) Apfel CC, Laara E, Koivuranta M,Greim CA, Roewer N. A simplified risk sore for predicting postoperative nausea and vomiting. Anesthesiology 1999; 91: 693-700.
15) Divatia JV, Vaidya JS, Badwe RA,Hawaldar RW. Omission of nitrous oxide during anesthesia reduces the incidence of postoperative nausea and vomiting. A meta-analysis. Anesthesiology 1996; 85: 1055-62.
16) Tramer MR. A rational approach to the control of postoperative nausea and vomiting: evidence from systematic reviews. Part II. Recommendations for prevention and treatment,and research agenda. Acta Anaesthesiol Scand 2001; 45: 14-19.
17) Greif R, Laciny S, Rapf B et al. Supplemental oxygen reduces the incidence of postoperative nausea and vomiting. Anesthesiology 1999; 91: 1246-52.
18) White PF, Shafer A. Nausea and vomiting: Causes and prophylaxis. Semin Anesth 1988; 6: 300-308.
19) Anderson R, Krohg K. Pain as a major cause of postoperative nausea. Can Anaesth Soc J 1976; 23: 366-369.
20) Michaloliakua C, Chung F, Sharma. Preoperative multimodal analgesia facilitates recovery after ambulatory laparoscopic cholecystectomy. Anesth Analg 1996; 82: 44-51.
21) Narchi P, Lecoq G, Fernandez H, Benhamou D. Intraperitoneal local anesthetics and scapular pain following daycase laparoscopy. Lancet 1991; 338:1569-70.
22) Beers RA, Calimlim JR, Uddoh E, Esposito BF, Camporesi EM. A comparison of the cost-effectiveness of remifentanil versus fentanil as an adjuvant to general anesthesia for outpatient gynecologic surgery. Anesth Analg 2000; 91: 1420-5.