Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2020.08.004
Brazilian Journal of Anesthesiology
Clinical Research

Comparison of post-operative nausea and vomiting with intravenous versus inhalational anesthesia in laparotomic abdominal surgery: a randomized clinical trial

Comparação entre anestesia intravenosa e inalatória na náusea e vômito pós-operatório de laparotomia: estudo clínico randomizado

Amir Ahmadzadeh Amiri, Kasra Karvandian, Mohammad Ashouri, Mojgan Rahimi, Ali Ahmadzadeh Amiri

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Abstract

Background
Postoperative Nausea and Vomiting (PONV) is a multifactorial surgical complication with an unclear underlying cause. Anesthetic methods, patients' characteristics and the type of surgery are considered as factors affecting PONV. This study was designed to compare the effect of inhalational and intravenous anesthesia in abdominal surgery on the incidence and severity of PONV.

Methods
A single-blinded prospective randomized clinical trial on 105 patients aged 18 − 65 years was carried out. Patients were divided into two groups of Total Intravenous Anesthesia (TIVA) and inhalational anesthesia. The incidence and the severity of PONV were examined at 0, 2, 6, 12 and 24 hours after the surgery. The use of a rescue antiemetic was also evaluated.

Results
50.9% of the patients in the inhalation group and 17.3% of the patients in the intravenous group developed PONV (p <  0.001). The incidence of vomiting was reported in 11.3% of the inhalational group and 3.8% of the TIVA group (p =  0.15). 24.5% of patients in the inhalation group and 9.6% of patients in the intravenous group needed an antiemetic medication (p =  0.043).

Conclusion
The incidence of postoperative nausea and vomiting and the need for administration of an antiemetic rescue drug and the severity of nausea in patients were significantly lower in the TIVA group.

Keywords

PONV, General anesthesia, Intravenous anesthesia, Endotracheal anesthesia, Laparotomy

Resumo

Justificativa
Náusea e Vômito no Pós-Operatório (NVPO) é uma complicação multifatorial com etiologia não esclarecida. A técnica anestésica, as características dos pacientes e o tipo de cirurgia são considerados fatores que afetam a NVPO. O presente estudo foi desenhado para comparar o efeito da anestesia inalatória com anestesia intravenosa na incidência e gravidade de NVPO na cirurgia abdominal.

Método
Foi realizado estudo clínico mono-cego prospectivo randomizado com 105 pacientes com idades de 18 − 65 anos. Os pacientes foram divididos em dois grupos, Anestesia Total Intravenosa (TIVA) e anestesia inalatória. A incidência e gravidade de NVPO foram avaliadas em cinco momentos: 0, 2, 6, 12 e 24 horas pós-cirurgia. O uso de antiemético de resgate também foi avaliado.

Resultados
NVPO ocorreu em 50,9% dos pacientes no grupo inalatória e 17,3% dos pacientes no grupo TIVA (p <  0,001). A incidência de vômitos relatados foi 11,3% no grupo inalatória e 3,8% no grupo TIVA (p =  0,15). Necessitaram de medicação antiemética 24,5% dos pacientes no grupo inalatória e 9,6% dos pacientes no grupo TIVA (p =  0.043).

Conclusão
A incidência de náusea e vômito no pós-operatório, a necessidade de administração de droga antiemética de resgate e a gravidade da náusea foram significantemente mais baixas no grupo TIVA.

Palavras-chave

NVPO,  Anestesia geral,  Anestesia intravenosa,  Anestesia endotraqueal,  Laparotomia

References

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