title: Intravenous dextrose administration reduces postoperative antiemetic rescue treatment requirements and postanesthesia care unit length of stay.
abstract: BACKGROUND
  Postoperative nausea and vomiting (PONV) remains the most common postoperative complication, and causes decreased patient satisfaction, prolonged postoperative hospital stays, and unanticipated admission. There are limited data that indicate that dextrose may reduce nausea and vomiting. In this trial, we attempted to determine whether the rate of PONV can be decreased by postoperative administration of IV dextrose bolus.
  
  
  METHODS
  To test the effect of postoperative dextrose administration on PONV rates, we conducted a double-blind, randomized, placebo-controlled trial. We enrolled 62 nondiabetic, ASA class I or II nonsmoking outpatients scheduled for gynecologic laparoscopic and hysteroscopic procedures. Patients were randomized into 2 groups: the treatment group received dextrose 5% in Ringer lactate solution, and the control (placebo) group received Ringer lactate solution given immediately after surgery. All patients underwent a standardized general anesthesia and received 1 dose of antiemetic a half hour before emergence from anesthesia. PONV scores, antiemetic rescue medications, narcotic consumption, and discharge time were recorded in the postanesthesia care unit (PACU) in half-hour intervals.
  
  
  RESULTS
  The 2 groups were similar with regard to age, weight, anxiety scores, prior PONV, non per os status, presurgical glucose, anesthetic duration, intraoperative narcotic use, and total weight-based fluid volume received. Postoperative nausea scores were not significantly different in the dextrose group compared with the control group (P > 0.05) after Bonferroni correction for repeated measurements over time. However, patients who received dextrose 5% in Ringer lactate solution consumed less rescue antiemetic medications (ratio mean difference, 0.56; 95% confidence interval, 0.39-0.82; P = 0.02), and had a shorter length of stay in the PACU (ratio mean difference, 0.80; 95% confidence interval, 0.66-0.97; P = 0.03) compared with patients in the control group.
  
  
  CONCLUSIONS
  In this trial, postanesthesia IV dextrose administration resulted in improved PONV management as defined by reductions in antiemetic rescue medication requirements and PACU length of stay that are worthy of further study. In light of its ease, low risk, and benefit to patient care and satisfaction, this therapeutic modality could be considered.
authors.affiliation: From the Department of Anesthesiology, Yale School of Medicine, New Haven, CT; PACU Nursing and Acute Pain Service, Yale New Haven Hospital, New Haven, CT; Pharmacy Department, Yale New Haven Hospital, New Haven, CT; and Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut, Veterans Administration Medical Health Systems/Yale School of Medicine.
authors.forename: Susan
authors.initials: S
authors.lastname: Dabu-Bondoc
authors.forename: Nalini
authors.initials: N
authors.lastname: Vadivelu
authors.forename: Chantelle
authors.initials: C
authors.lastname: Shimono
authors.forename: Annette
authors.initials: A
authors.lastname: English
authors.forename: Boonsri
authors.initials: B
authors.lastname: Kosarussavadi
authors.forename: Feng
authors.initials: F
authors.lastname: Dai
authors.forename: Kirk
authors.initials: K
authors.lastname: Shelley
authors.forename: Jessica
authors.initials: J
authors.lastname: Feinleib
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures; D000768:Anesthesia, General; D000932:Antiemetics / Q000627:therapeutic use*; D003422:Critical Care / Q000706:statistics & numerical data*; D004311:Double-Blind Method; D005260:Female; D005947:Glucose / Q000008:administration & dosage / Q000627:therapeutic use*; D013509:Gynecologic Surgical Procedures; D006801:Humans; D015907:Hysteroscopy; D007275:Injections, Intravenous; D007362:Intensive Care Units / Q000706:statistics & numerical data; D010535:Laparoscopy; D007902:Length of Stay; D008875:Middle Aged; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control*; D012996:Solutions; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000932:Antiemetics; D012996:Solutions; D005947:Glucose