; Preoperative Fluid Bolus and Reduction of Postoperative Nausea and Vomiting in Patients Undergoing Laparoscopic Gynecologic Surgery
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Preoperative Fluid Bolus and Reduction of Postoperative Nausea and Vomiting in Patients Undergoing Laparoscopic Gynecologic Surgery

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We conducted a randomized clinical trial of patients undergoing laparoscopic gynecologic surgery to determine the effect of a calculated preoperative fluid bolus on postoperative nausea and vomiting (PONV). For the study, 46 women were randomly assigned to an experimental group, group 1, or a control group, group 2. Group 1 received up to 1,000 mL of replacement fluid preoperatively, using the 4-2-1 formula. Group 2 received the anesthesia provider's routine replacement fluids. Neither group received antiemetics preoperatively or intraoperatively. All patients were assessed for PONV by nurses blinded to patient group assignment. Group 1 patients experienced significantly lower occurrences of PONV than did group 2 patients (P = .046). The preoperative fluid bolus seemed to be a significant factor in preventing PONV in group 1. Demographic and other factors reported to cause PONV, such as the length of surgery and major manipulation of the bowels, were similar in both groups. There was no significant difference between groups in reception of postoperative opioid, a known cause of PONV. Drops in blood pressure were thought to affect PONV, but group 1 patients had larger decreases in blood pressure than did group 2 patients.

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									Preoperative Fluid Bolus and Reduction of
Postoperative Nausea and Vomiting in Patients
Undergoing Laparoscopic Gynecologic Surgery

Kathy Guinn Lambert, CRNA, MSN
Judith H. Wakim, RN, EdD, CNE
Nicholas E. Lambert, CRNA, MSN

 We conducted a randomized clinical trial of patients            The preoperative fluid bolus seemed to be a signif-
 undergoing laparoscopic gynecologic surgery to deter-        icant factor in preventing PONV in group 1. Demo-
 mine the effect of a calculated preoperative fluid bolus     graphic and other factors reported to cause PONV,
 on postoperative nausea and vomiting (PONV).                 such as the length of surgery and major manipulation
    For the study, 46 women were randomly assigned            of the bowels, were similar in both groups. There was
 to an experimental group, group 1, or a control group,       no significant difference between groups in reception
 group 2. Group 1 received up to 1,000 mL of replace-         of postoperative opioid, a known cause of PONV.
 ment fluid preoperatively, using the 4-2-1 formula.          Drops in blood pressure were thought to affect PONV,
 Group 2 received the anesthesia provider’s routine           but group 1 patients had larger decreases in blood
 replacement fluids. Neither group received antiemet-         pressure than did group 2 patients.
 ics preoperatively or intraoperatively. All patients were
 assessed for PONV by nurses blinded to patient group
 assignment. Group 1 patients experienced signifi-            Keywords: Laparoscopic gynecologic surgery, postop-
 cantly lower occurrences of PONV than did group 2            erative nausea and vomiting reduction, preoperative
 patients (P = .046).                                         fluid bolus.



           ostoperative nausea and vomiting (PONV) is an      patients given the usual lactated Ringer’s solution in an



P          undesirable complication of general surgery
           resulting in prolonged recovery time, delayed
           patient discharge, patient dissatisfaction and
           discomfort, increased morbidity and mortality,
and increased healthcare costs. The overall incidence of
PONV for all surgeries has been estimated to be 25% to
30% and up to 70% in high-risk groups. Laparoscopic sur-
                                                              amount determined by the anesthesia provider. An analy-
                                                              sis of variance showed the results were significant (P <
                                                              .05); however, neither hours of fasting nor use of
                                                              antiemetics were controlled.
                                                                  Magner et al1 reported the effects of an intravenous in-
                                                              fusion of 30 mL/kg compared with that of 10 mL/kg given
                                                              intraoperatively to 2 groups, each including 35 patients
gery, gynecological laparoscopic surgery in particular, is    undergoing gynecologic laparoscopic surgery. An inde-
linked to an increased incidence of PONV.1,2                  pendent t test demonstrated that the occurrence of vom-
    Studies conducted by Ho and Chiu,2 Nelson,3 Push et       iting was less in the group receiving 30 mL/kg than in the
   4
al, and Hagemann et al5 identified dehydration and rela-      group receiving 10 mL/kg (8.6% vs 25.7%; P = .01).
tive hypovolemia as factors contributing to the incidence         Another study of 80 patients undergoing gynecologic
of PONV. Preoperative dehydration occurs following            laparoscopic surgery reported the effect of a large volume
mandatory bowel preparation and preoperative fasting.         of intravenous fluids on the occurrence of PONV.7 The
Preoperative dehydration can result in hypotension at the     control group received 3 mL/kg of compound sodium
time of anesthesia. Ho and Chiu2 noted that a greater than    lactate, and the experimental group received 2 mL/kg of
35% reduction in systolic blood pressure on anesthesia in-    compound sodium lactate times the number of hours
duction was associated with an increase in PONV.              since the
								
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