Perioperative hemodynamic optimization in laparoscopic sleeve gastrectomy using stroke volume variation to reduce postoperative nausea and vomiting

Han-Jung Cho; Yi-Hsuan Huang; Kin-Shing Poon; Kuen-Bao Chen; Kate Hsiurong Liao

doi:10.1016/j.soard.2021.06.004

Perioperative hemodynamic optimization in laparoscopic sleeve gastrectomy using stroke volume variation to reduce postoperative nausea and vomiting

Surg Obes Relat Dis. 2021 Sep;17(9):1549-1557. doi: 10.1016/j.soard.2021.06.004. Epub 2021 Jun 19.

Authors

Han-Jung Cho¹, Yi-Hsuan Huang¹, Kin-Shing Poon², Kuen-Bao Chen², Kate Hsiurong Liao³

Affiliations

¹ Department of Anesthesiology, China Medical University Hospital, Taichung, Taiwan.
² Department of Anesthesiology, China Medical University Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan.
³ Department of Anesthesiology, China Medical University Hospital, Taichung, Taiwan; School of Chinese Medicine, China Medical University, Taichung, Taiwan. Electronic address: D12748@mail.cmuh.org.tw.

PMID: 34247980
DOI: 10.1016/j.soard.2021.06.004

Abstract

Background: Risk of postoperative nausea and vomiting (PONV) is usually high among patients undergoing laparoscopic sleeve gastrectomy (LSG). Perioperative hemodynamic optimization using goal-directed fluid therapy (GDFT) based on stroke volume variation (SVV) has been suggested to reduce PONV.

Objectives: This study aimed to investigate the effectiveness of GDFT on reducing PONV.

Setting: The operating rooms in China Medical University Hospital.

Methods: This prospective cohort study included 75 patients undergoing LSG. Patients were randomized into 3 groups: controls (conventional fluid therapy), GDFT-hydroxyethyl starch (GH), and GDFT-lactated Ringer's (GL) groups. In both GDFT groups, optimization of fluid administration was achieved by continuous monitoring and adjusting of SVV. Severity of PONV was evaluated using a standardized questionnaire. Other clinically relevant events, including in-hospital surgical site infections and length of hospital stay were also investigated.

Results: In the GH group, the total volume of fluid administered intraoperatively was significantly lower than that in the GL and control groups (P < .001). Assessment of PONV severity showed a significantly higher score at postoperative 24 hours in the GH group (P < .05), while no significant differences were found between the 3 groups at postoperative 48 hours. No significant differences were observed between the 3 groups in surgical site infections and length of hospital stay.

Conclusion: No significant benefit is found in reducing PONV by using GDFT in patients undergoing LSG, although GDFT effectively avoids excessive volume of fluid administration. PONV incidence appears to be higher with intraoperative colloid infusion for GDFT during LSG. Further investigation is warranted to elucidate the mechanism underlying PONV in postoperative LSG.

Keywords: Goal-directed fluid therapy; Laparoscopic sleeve gastrectomy; Postoperative nausea and vomiting.

Publication types

Randomized Controlled Trial

MeSH terms

Gastrectomy / adverse effects
Humans
Laparoscopy*
Postoperative Nausea and Vomiting* / etiology
Postoperative Nausea and Vomiting* / prevention & control
Prospective Studies
Stroke Volume