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
ARTICLE HIGHLIGHTS
Research background

Postoperative nausea and vomiting (PONV) remains prevalent after general anesthesia, especially after gynecological laparoscopic surgery. The pathogenesis of PONV is multifactorial, and its etiology and pathogenesis are not clear. Suboptimal gastrointestinal (GI) perfusion may be responsible for some cases of PONV, and there are risk factors for suboptimal GI perfusion in patients undergoing laparoscopic hysterectomy. Furthermore, increased systemic vascular resistance (SVR) is related to suboptimal GI perfusion. However, there is currently no research on the relationship between SVR and PONV.

Research motivation

Female sex, a history of motion sickness or PONV, nonsmokers, and perioperative opioid use are the most closely related risk factors for PONV. Suboptimal GI perfusion may be attributed to some cases of PONV, and an increased SVR may lead to GI ischemia. The present study analyzed the relationship between SVR indices and PONV after laparoscopic hysterectomy, which may assist in the prevention of PONV in the future.

Research objectives

The aim of this prospective observational study was to observe the associations between SVR and PONV in patients undergoing laparoscopic hysterectomy. Four SVR indices, the baseline, mean, area under the curve (AUC) and weighted AUC, were assessed through logistic regression analysis. Moreover, we compared the outcomes of PONV patients and non-PONV patients.

Research methods

We performed a prospective observational study of patients undergoing laparoscopic hysterectomy.

Research results

The incidence of PONV after laparoscopic hysterectomy in our institution was 56.14%, and PONV mostly occurred roughly within 6 h after surgery. SVR mean and duration of surgery were associated with PONV. High SVR mean was associated with a significantly increased risk of PONV in this study. Furthermore, patients who developed PONV needed more time to tolerate diet and demonstrated poorer sleep quality on the first night after surgery.

Research conclusions

SVR mean and duration of surgery were associated with PONV after laparoscopic hysterectomy. Patients with high SVR mean were more likely to develop PONV.

Research perspectives

Although we administered many prophylactic measures, the incidence of PONV remained very high, especially after gynecological laparoscopic surgery. More randomized controlled trials should be performed to explore precautions that can reduce the occurrence of PONV.