scholarly journals Effect of Intraoperative High Inspired Oxygen Fraction on Surgical Site Infection, Postoperative Nausea and Vomiting, and Pulmonary Function

2013 ◽  
Vol 119 (2) ◽  
pp. 303-316 ◽  
Author(s):  
Frédérique Hovaguimian ◽  
Christopher Lysakowski ◽  
Nadia Elia ◽  
Martin R. Tramèr
Keyword(s):  
Risk Ratio ◽  
Postoperative Nausea ◽  
Postoperative Nausea And Vomiting ◽  
Prophylactic Antibiotics ◽  
Nausea And Vomiting ◽  
Site Infection ◽  
Oxygen Fraction ◽  
High Fio2 ◽  
Postoperative Atelectasis ◽  
Inspired Oxygen

Abstract Background: Intraoperative high inspired oxygen fraction (Fio2) is thought to reduce the incidence of surgical site infection (SSI) and postoperative nausea and vomiting, and to promote postoperative atelectasis. Methods: The authors searched for randomized trials (till September 2012) comparing intraoperative high with normal Fio2 in adults undergoing surgery with general anesthesia and reporting on SSI, nausea or vomiting, or pulmonary outcomes. Results: The authors included 22 trials (7,001 patients) published in 26 reports. High Fio2 ranged from 80 to 100% (median, 80%); normal Fio2 ranged from 30 to 40% (median, 30%). In nine trials (5,103 patients, most received prophylactic antibiotics), the incidence of SSI decreased from 14.1% with normal Fio2 to 11.4% with high Fio2; risk ratio, 0.77 (95% CI, 0.59–1.00). After colorectal surgery, the incidence of SSI decreased from 19.3 to 15.2%; risk ratio, 0.78 (95% CI, 0.60–1.02). In 11 trials (2,293 patients), the incidence of nausea decreased from 24.8% with normal Fio2 to 19.5% with high Fio2; risk ratio, 0.79 (95% CI, 0.66–0.93). In patients receiving inhalational anesthetics without prophylactic antiemetics, high Fio2 provided a significant protective effect against both nausea and vomiting. Nine trials (3,698 patients) reported on pulmonary outcomes. The risk of atelectasis was not increased with high Fio2. Conclusions: Intraoperative high Fio2 further decreases the risk of SSI in surgical patients receiving prophylactic antibiotics, has a weak beneficial effect on nausea, and does not increase the risk of postoperative atelectasis.

Inspired Oxygen Fraction of 0.8 Does Not Attenuate Postoperative Nausea and Vomiting after Strabismus Surgery

2005 ◽  
Vol 103 (1) ◽  
pp. 6-10 ◽  
Author(s):  
Tanja A. Treschan ◽  
Christian Zimmer ◽  
Christoph Nass ◽  
Bernd Stegen ◽  
Joachim Esser ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Intravenous Administration ◽  
Postoperative Nausea ◽  
Postoperative Nausea And Vomiting ◽  
Strabismus Surgery ◽  
Nausea And Vomiting ◽  
Controlled Study ◽  
Oxygen Fraction ◽  
Significant Difference ◽  
Inspired Oxygen

Background Postoperative nausea and vomiting (PONV) is a distressing problem after strabismus surgery. An inspired oxygen fraction has been reported to decrease PONV in patients after colon resection and to be more effective than ondansetron after gynecologic laparoscopy. Therefore, in a randomized, prospective, placebo-controlled study, the authors tested whether an inspired oxygen fraction of 0.8 decreases PONV in patients undergoing strabismus surgery and whether oxygen is more effective than ondansetron. Methods With approval of the authors' institutional review board, 210 patients were randomly assigned to receive one of three treatments: (1) 30% inspired oxygen in air plus intravenous administration of saline, (2) 80% inspired oxygen in air plus intravenous administration of saline, or (3) 30% inspired oxygen in air plus 75 microg/kg ondansetron intravenously during induction. General anesthesia was standardized and included etomidate, alfentanil, and mivacurium for induction and sevoflurane for maintenance. PONV was evaluated 6 and 24 h postoperatively by an investigator unaware of treatment assignment. Results Overall postoperative incidence of nausea and vomiting was 41% for inspired oxygen fraction of 0.3 plus placebo, 38% for inspired oxygen fraction of 0.8 plus placebo, and 28% for inspired oxygen fraction of 0.3 plus ondansetron, respectively (P = 0.279). Therefore, there was no statistically significant difference of PONV incidence among groups. Conclusions An inspired oxygen fraction of 0.8 during general anesthesia with sevoflurane does not decrease PONV in patients undergoing strabismus repair. Ondansetron also did not significantly decrease PONV in our study setting.

scholarly journals Effects of high intraoperative inspired oxygen on postoperative nausea and vomiting in gynecologic laparoscopic surgery

2010 ◽  
Vol 22 (7) ◽  
pp. 492-498 ◽  
Author(s):  
Tatjana Šimurina ◽  
Boris Mraović ◽  
Simon Mikulandra ◽  
Zdenko Sonicki ◽  
Nina Sulen ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Postoperative Nausea ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Inspired Oxygen

Nitrous Oxide–related Postoperative Nausea and Vomiting Depends on Duration of Exposure

2014 ◽  
Vol 120 (5) ◽  
pp. 1137-1145 ◽  
Author(s):  
Philip J. Peyton ◽  
Christine Yx Wu
Keyword(s):  
Nitrous Oxide ◽  
Risk Ratio ◽  
Postoperative Nausea ◽  
Ambulatory Surgery ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Number Needed To Treat ◽  
Inclusion Criteria ◽  
Meta Regression ◽  
Clinically Significant

Abstract Background Inclusion of nitrous oxide in the gas mixture has been implicated in postoperative nausea and vomiting (PONV) in numerous studies. However, these studies have not examined whether duration of exposure was a significant covariate. This distinction might affect the future place of nitrous oxide in clinical practice. Methods PubMed listed journals reporting trials in which patients randomized to a nitrous oxide or nitrous oxide–free anesthetic for surgery were included, where the incidence of PONV within the first 24 postoperative hours and mean duration of anesthesia was reported. Meta-regression of the log risk ratio for PONV with nitrous oxide (lnRR PONVN2O) versus duration was performed. Results Twenty-nine studies in 27 articles met the inclusion criteria, randomizing 10,317 patients. There was a significant relationship between lnRR PONVN2O and duration (r2 = 0.51, P = 0.002). Risk ratio PONV increased 20% per hour of nitrous oxide after 45 min. The number needed to treat to prevent PONV by avoiding nitrous oxide was 128, 23, and 9 where duration was less than 1, 1 to 2, and over 2 h, respectively. The risk ratio for the overall effect of nitrous oxide on PONV was 1.21 (CIs, 1.04–1.40); P = 0.014. Conclusions This duration-related effect may be via disturbance of methionine and folate metabolism. No clinically significant effect of nitrous oxide on the risk of PONV exists under an hour of exposure. Nitrous oxide–related PONV should not be seen as an impediment to its use in minor or ambulatory surgery.

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