title: Preoperative intravenous fluid therapy decreases postoperative nausea and pain in high risk patients.
abstract: The potential for preoperative IV rehydration to reduce postoperative nausea and vomiting (PONV) and pain in patients undergoing ambulatory surgery remains unclear, with conflicting results reported. We sought to determine whether preoperative IV rehydration with a balanced salt solution would decrease the incidence of PONV in patients at increased risk for these symptoms. Eighty ASA grade I-III patients presenting for gynecologic laparoscopy were randomized to receive large (2 mL/kg per hour fasting) or small (3 mL/kg) volume infusions of compound sodium lactate solution over 20 min preoperatively. A standardized balanced anesthetic was used. The incidence and severity of PONV and pain, and need for supplemental antiemetic and analgesic therapy, were assessed by a blinded investigator at 0.5, 1, and 4 h postoperatively, and on the first and third postoperative days. The incidence (control 87% versus large volume 59%) and severity of PONV were significantly reduced in the large volume infusion group at all time intervals. The large volume infusion group also had decreased postoperative pain scores and required less supplemental analgesia. Preoperative correction of intravascular volume deficits effectively reduces PONV and postoperative pain in high risk patients presenting for ambulatory surgery. We recommend the preoperative administration of 2 mL/kg of compound sodium lactate for every hour of fasting to patients with an increased PONV risk presenting for ambulatory surgery.
authors.affiliation: *Department of Anaesthesia and Intensive Care Medicine, University College Hospital; and †Department of Anaesthesia, Clinical Sciences Institute, National University of Ireland, Galway, Ireland.
authors.forename: C H
authors.initials: CH
authors.lastname: Maharaj
authors.forename: S R
authors.initials: SR
authors.lastname: Kallam
authors.forename: A
authors.initials: A
authors.lastname: Malik
authors.forename: P
authors.initials: P
authors.lastname: Hassett
authors.forename: D
authors.initials: D
authors.lastname: Grady
authors.forename: J G
authors.initials: JG
authors.lastname: Laffey
mesh_terms: D000328:Adult; D004311:Double-Blind Method; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D007262:Infusions, Intravenous; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control*; D011300:Preoperative Care
references.citation: Cholwill JM, Wright W, Hobbs GJ, Curran J. Comparison of ondansetron and cyclizine for prevention of nausea and vomiting after day-case gynaecological laparoscopy. Br J Anaesth 1999;83:611–4.
references.citation: Macario A, Weinger M, Carney S, Kim A. Which clinical anesthesia outcomes are important to avoid? The perspective of patients. Anesth Analg 1999;89:652–8.
references.citation: Chung F, Mezei G. Factors contributing to a prolonged stay after ambulatory surgery. Anesth Analg 1999;89:1352–9.
references.citation: Gold BS, Kitz DS, Lecky JH, Neuhaus JM. Unanticipated admission to the hospital following ambulatory surgery. JAMA 1989;262:3008–10.
references.citation: Cohen MM, Duncan PG, DeBoer DP, Tweed WA. The postoperative interview: assessing risk factors for nausea and vomiting. Anesth Analg 1994;78:7–16.
references.citation: Apfel CC, Laara E, Koivuranta M, et al. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Anesthesiology 1999;91:693–700.
references.citation: Gan TJ, Meyer T, Apfel CC, et al. Consensus guidelines for managing postoperative nausea and vomiting. Anesth Analg 2003;97:62–71.
references.citation: Yogendran S, Asokumar B, Cheng DC, Chung F. A prospective randomized double-blinded study of the effect of intravenous fluid therapy on adverse outcomes on outpatient surgery. Anesth Analg 1995;80:682–6.
references.citation: Cook R, Anderson S, Riseborough M, Blogg CE. Intravenous fluid load and recovery: a double-blind comparison in gynaecological patients who had day-case laparoscopy. Anaesthesia 1990;45:826–30.
references.citation: Ooi LG, Goldhill DR, Griffiths A, Smith C. IV fluids and minor gynaecological surgery: effect on recovery from anaesthesia. Br J Anaesth 1992;68:576–9.
references.citation: Keane PW, Murray PF. Intravenous fluids in minor surgery: their effect on recovery from anaesthesia. Anaesthesia 1986;41:635–7.
references.citation: McCaul C, Moran C, O'Cronin D, et al. Intravenous fluid loading with or without supplementary dextrose does not prevent nausea, vomiting and pain after laparoscopy. Can J Anaesth 2003;50:440–4.
references.citation: Spencer EM. Intravenous fluids in minor gynaecological surgery: their effect on postoperative morbidity. Anaesthesia 1988;43:1050–1.
references.citation: Ali SZ, Taguchi A, Holtmann B, Kurz A. Effect of supplemental pre-operative fluid on postoperative nausea and vomiting. Anaesthesia 2003;58:780–4.
references.citation: Collins KM, Docherty PW, Plantevin OM. Postoperative morbidity following gynaecological outpatient laparoscopy: a reappraisal of the service. Anaesthesia 1984;39:819–22.
references.citation: Holte K, Jensen P, Kehlet H. Physiologic effects of intravenous fluid administration in healthy volunteers. Anesth Analg 2003;96:1504–9.
references.citation: Cook RJ, Sackett DL. The number needed to treat: a clinically useful measure of treatment effect. BMJ 1995;310:452–4.
references.citation: Tramer MR, Reynolds DJ, Moore RA, McQuay HJ. Efficacy, dose-response, and safety of ondansetron in prevention of postoperative nausea and vomiting: a quantitative systematic review of randomized placebo-controlled trials. Anesthesiology 1997;87:1277–89.