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Effects of hypercapnia on postoperative nausea and vomiting after laparoscopic surgery: a double-blind randomized controlled study

Surgical Endoscopy volume 31, pages 4576–4582 (2017)Cite this article

Abstract

Background

Laparoscopic surgery is associated with a high incidence of postoperative nausea and vomiting (PONV). The use of CO2 pneumoperitoneum has been proposed as a potential cause of high PONV incidence. However, intraoperative hypercarbia may be related to enhanced perfusion to the main effector sites for PONV, including the brain and gastrointestinal tract. In this study, we investigated whether an increase in intraoperative CO2 partial pressure in arterial blood (PaCO2) reduces the incidence of PONV.

Methods

This study enrolled 400 female patients aged 20–60 years who were undergoing laparoscopic gynecologic surgery. The patients were allocated randomly to one of three groups with the following intraoperative PaCO2 levels: 36–40 mmHg (Group 1), 41–45 mmHg (Group 2), or 46–50 mmHg (Group 3). The anesthetic regimen used a standardized total intravenous anesthesia consisting of propofol and remifentanil for all patients. The arterial blood gas analysis was performed to identify the difference in CO2 partial pressure between arterial blood and end-tidal gas. The PONV incidence was evaluated for the periods of 0–2, 2–6, and 6–24 h after anesthesia. The incidence and severity of PONV and the administration of rescue antiemetics were recorded.

Results

The three groups were comparable for the patient, anesthesia, and surgical characteristics. The average PaCO2 level during surgery was 38–39, 43–44, and 47–48 mmHg in Groups 1, 2, and 3, respectively. The incidence and severity of PONV and use of rescue antiemetics were not significantly different among the groups. The overall incidence of nausea during the first 24-h postoperative period was 54, 48, and 50% in Groups 1, 2, and 3, respectively (P = 0.593).

Conclusion

Our data suggest that mild to moderate intraoperative hypercapnia did not decrease the incidence and severity of PONV or the requirement for rescue antiemetics after gynecologic laparoscopic surgery.

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References

  1. McMahon AJ, Russell IT, Baxter JN, Ross S, Anderson JR, Morran CG, Sunderland G, Galloway D, Ramsay G, O’Dwyer PJ (1994) Laparoscopic versus minilaparotomy cholecystectomy: a randomised trial. Lancet 343:135–138

    CAS  Article  PubMed  Google Scholar 

  2. Chen HH, Wexner SD, Iroatulam AJ, Pikarsky AJ, Alabaz O, Nogueras JJ, Nessim A, Weiss EG (2000) Laparoscopic colectomy compares favorably with colectomy by laparotomy for reduction of postoperative ileus. Dis Colon Rectum 43:61–65

    CAS  Article  PubMed  Google Scholar 

  3. Gan TJ, Diemunsch P, Habib AS, Kovac A, Kranke P, Meyer TA, Watcha M, Chung F, Angus S, Apfel CC, Bergese SD, Candiotti KA, Chan MT, Davis PJ, Hooper VD, Lagoo-Deenadayalan S, Myles P, Nezat G, Philip BK, Tramer MR, Society for Ambulatory A (2014) Consensus guidelines for the management of postoperative nausea and vomiting. Anesth Analg 118:85–113

    Article  PubMed  Google Scholar 

  4. Goll V, Akca O, Greif R, Freitag H, Arkilic CF, Scheck T, Zoeggeler A, Kurz A, Krieger G, Lenhardt R, Sessler DI (2001) Ondansetron is no more effective than supplemental intraoperative oxygen for prevention of postoperative nausea and vomiting. Anesth Analg 92:112–117

    CAS  Article  PubMed  Google Scholar 

  5. Koivusalo AM, Kellokumpu I, Scheinin M, Tikkanen I, Makisalo H, Lindgren L (1998) A comparison of gasless mechanical and conventional carbon dioxide pneumoperitoneum methods for laparoscopic cholecystectomy. Anesth Analg 86:153–158

    CAS  PubMed  Google Scholar 

  6. Ho HS, Saunders CJ, Gunther RA, Wolfe BM (1995) Effector of hemodynamics during laparoscopy: CO2 absorption or intra-abdominal pressure? J Surg Res 59:497–503

    CAS  Article  PubMed  Google Scholar 

  7. Apfel CC, Laara E, Koivuranta M, Greim CA, Roewer N (1999) A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Anesthesiology 91:693–700

    CAS  Article  PubMed  Google Scholar 

  8. Watcha MF, White PF (1992) Postoperative nausea and vomiting. Its etiology, treatment, and prevention. Anesthesiology 77:162–184

    CAS  Article  PubMed  Google Scholar 

  9. Fredman B, Jedeikin R, Olsfanger D, Flor P, Gruzman A (1994) Residual pneumoperitoneum: a cause of postoperative pain after laparoscopic cholecystectomy. Anesth Analg 79:152–154

    CAS  PubMed  Google Scholar 

  10. Beuk RJ, Heineman E, Tangelder GJ, Kurvers HA, Bonke HJ, Oude Egbrink MG (1997) Effects of different durations of total warm ischemia of the gut on rat mesenteric microcirculation. J Surg Res 73:14–23

    CAS  Article  PubMed  Google Scholar 

  11. Marston A (1977) Responses of the splanchnic circulation to ischaemia. J Clin Pathol Suppl (R Coll Pathol) 11:59–67

    CAS  Article  Google Scholar 

  12. Josephs LG, Este-McDonald JR, Birkett DH, Hirsch EF (1994) Diagnostic laparoscopy increases intracranial pressure. J Trauma 36:815–819

    CAS  Article  PubMed  Google Scholar 

  13. Andrews PL (1992) Physiology of nausea and vomiting. Br J Anaesth 69:2S–19S

    CAS  Article  PubMed  Google Scholar 

  14. Kim D-K, Cheong I-Y, Lee G-Y, Cho J-H (2006) Low Pressure (8 mmHg) Pneumoperitoneum does not Reduce the Incidence and Severity of Postoperative Nausea and Vomiting (PONV) following Gynecologic Laparoscopy. Korean J Anesthesiol 50:S36–S42

    Article  Google Scholar 

  15. Ren H, Tong Y, Ding XB, Wang X, Jin SQ, Niu XY, Zhao X, Li Q (2014) Abdominal wall-lifting versus CO2 pneumoperitoneum in laparoscopy: a review and meta-analysis. Int J Clin Exp Med 7:1558–1568

    PubMed  PubMed Central  Google Scholar 

  16. Mas A, Saura P, Joseph D, Blanch L, Baigorri F, Artigas A, Fernandez R (2000) Effect of acute moderate changes in PaCO2 on global hemodynamics and gastric perfusion. Crit Care Med 28:360–365

    CAS  Article  PubMed  Google Scholar 

  17. Akca O, Doufas AG, Morioka N, Iscoe S, Fisher J, Sessler DI (2002) Hypercapnia improves tissue oxygenation. Anesthesiology 97:801–806

    CAS  Article  PubMed  Google Scholar 

  18. Fleischmann E, Herbst F, Kugener A, Kabon B, Niedermayr M, Sessler DI, Kurz A (2006) Mild hypercapnia increases subcutaneous and colonic oxygen tension in patients given 80% inspired oxygen during abdominal surgery. Anesthesiology 104:944–949

    Article  PubMed  Google Scholar 

  19. Wax DB, Lin HM, Hossain S, Porter SB (2010) Intraoperative carbon dioxide management and outcomes. Eur J Anaesthesiol 27:819–823

    Article  PubMed  Google Scholar 

  20. Pusch F, Berger A, Wildling E, Zimpfer M, Moser M, Sam C, Krafft P (2002) Preoperative orthostatic dysfunction is associated with an increased incidence of postoperative nausea and vomiting. Anesthesiology 96:1381–1385

    Article  PubMed  Google Scholar 

  21. Saghaei M, Matin G, Golparvar M (2014) Effects of intra-operative end-tidal carbon dioxide levels on the rates of post-operative complications in adults undergoing general anesthesia for percutaneous nephrolithotomy: a clinical trial. Adv Biomed Res 3:84

    Article  PubMed  PubMed Central  Google Scholar 

  22. Altay N, Yalcin S, Aydogan H, Kucuk A, Yuce HH (2015) Effects of end tidal CO2 and venous CO2 levels on postoperative nausea and vomiting in paediatric patients. Eur Rev Med Pharmacol Sci 19:4254–4260

    CAS  PubMed  Google Scholar 

  23. Gan TJ, Meyer T, Apfel CC, Chung F, Davis PJ, Eubanks S, Kovac A, Philip BK, Sessler DI, Temo J, Tramer MR, Watcha M (2003) Consensus guidelines for managing postoperative nausea and vomiting. Anesth Analg 97:62–71

    Article  PubMed  Google Scholar 

  24. Graczyk SG, McKenzie R, Kallar S, Hickok CB, Melson T, Morrill B, Hahne WF, Brown RA (1997) Intravenous dolasetron for the prevention of postoperative nausea and vomiting after outpatient laparoscopic gynecologic surgery. Anesth Analg 84:325–330

    CAS  Article  PubMed  Google Scholar 

  25. Boehler M, Mitterschiffthaler G, Schlager A (2002) Korean hand acupressure reduces postoperative nausea and vomiting after gynecological laparoscopic surgery. Anesth Analg 94:872–875

    Article  PubMed  Google Scholar 

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Affiliations

  1. Department of Anesthesiology and Pain Medicine and Research Institute of Clinical Medicine-Biomedical Research Institute, Chonbuk National University Medical School, Jeonju, South Korea

    Ji-Seon Son & Seonghoon Ko

  2. Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center, Jeonju, South Korea

    Ji-Yun Oh

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  1. Ji-Seon Son
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  2. Ji-Yun Oh
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Correspondence to Seonghoon Ko.

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Ji-Seon Son, Ji-Youn Oh, and Seonghoon Ko have no conflict of interests or financial ties to disclose.

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Son, JS., Oh, JY. & Ko, S. Effects of hypercapnia on postoperative nausea and vomiting after laparoscopic surgery: a double-blind randomized controlled study. Surg Endosc 31, 4576–4582 (2017). https://doi.org/10.1007/s00464-017-5519-8

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  • DOI: https://doi.org/10.1007/s00464-017-5519-8

Keywords

  • CO2 pneumoperitoneum
  • Hypercapnia
  • Laparoscopy
  • PONV