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Muscular tissue oxygen saturation during robotic hysterectomy and postoperative nausea and vomiting: exploring the potential therapeutic thresholds

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Abstract

The relationship between muscular tissue oxygen saturation (SmtO2) during surgery and postoperative nausea and vomiting (PONV) remains to be determined. Patients undergoing robotic hysterectomy participated in this prospective cohort study. SmtO2 of the brachioradialis muscle in the forearm was continuously monitored during surgery. Thresholds based on relative changes or absolute values were systematically assigned. The relationship between thresholds and PONV was investigated based on threshold analysis (i.e., exceeding or not exceeding a threshold), area under the curve analysis (i.e., the size of the area enclosed by the SmtO2 trace and threshold), and multivariable analysis by accounting for recognized PONV risk factors. PONV occurred in 35 of 106 patients (33%). Based on the multivariable analysis, the SmtO2 threshold of 20% above baseline correlated with less PONV (OR 0.39; 95% CI 0.16–0.93; p = 0.034), and the following values correlated with more PONV: 5% below baseline (OR 2.37; 95% CI 1.26–4.45; p = 0.007), 20% below baseline (OR 16.08; 95% CI 3.05–84.73; p = 0.001), < 70% (OR 2.86; 95% CI 1.17–6.99; p = 0.021) and < 60% (OR 6.55; 95% CI 1.11–38.53; p = 0.038). Our study suggests that a potential therapeutic goal for PONV prophylaxis may be to maintain SmtO2 at > 70% and above baseline.

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Acknowledgements

We thank CAS Medical Systems, Inc., Branford, CT, USA, for providing the FORE-SIGHT ELITE Tissue Oximeter at no cost.

Funding

Support provided from institutional and/or departmental sources at Yale University and Peking University.

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Authors and Affiliations

  1. Department of Anesthesiology, Peking University Third Hospital, 49 Huayuan N Rd, Haidian Qu, Beijing, China

    Gang Li & Xiangyang Guo

  2. Department of Anesthesiology, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China

    Liang Lin

  3. Department of Biostatistics, Yale University School of Public Health, Yale Center for Analytical Sciences, New Haven, CT, USA

    Feng Dai

  4. Department of Anesthesiology, Yale University School of Medicine, 333 Cedar Street, TMP 3, P.O. Box 208051, New Haven, CT, 06520, USA

    Lingzhong Meng

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  1. Gang Li
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Contributions

GL contributed to the study design and the interpretation and acquisition of the data. LL contributed to the study design and acquisition of the data. FD contributed to analysis and interpretation of the data. XG contributed to the interpretation of the data. LM contributed to the study design and the acquisition and interpretation of the data. All authors were involved in the writing and revising of the manuscript.

Corresponding authors

Correspondence to Xiangyang Guo or Lingzhong Meng.

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Conflict of interest

LM is a consultant to CAS Medical Systems, Inc. The other authors declare no conflicts of interest.

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Informed consent was obtained from all individual participants included in the study.

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Li, G., Lin, L., Dai, F. et al. Muscular tissue oxygen saturation during robotic hysterectomy and postoperative nausea and vomiting: exploring the potential therapeutic thresholds. J Clin Monit Comput 33, 597–604 (2019). https://doi.org/10.1007/s10877-018-0193-5

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  • DOI: https://doi.org/10.1007/s10877-018-0193-5

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