When your patient arrives in the PACU, what kinds of fluid do you ask the PACU nurse to administer? Does the fluid contain dextrose? Maybe it should!
There’s evidence that dextrose administration decreases postoperative nausea and vomiting. However, the story isn’t completely clear. For example, last month, AA2day summarized a study that showed dextrose administered at the end of surgery did not have any effect on treating PONV.
The findings are somewhat different in the paper “Intravenous Dextrose Administration Reduces Postoperative Antiemetic Rescue Treatment Requirements and Postanesthesia Care Unit Length of Stay” published in this month’s issue of Anesthesia & Analgesia. Dr. Susan Dabu-Bondoc, Department of Anesthesiology, Yale School of Medicine, New Haven, CT and colleagues hypothesized that when an IV solution containing dextrose was given to patients undergoing gynecologic procedures, PONV incidence would be less.
The authors randomized 64 patients to receive one liter of either D5LR or LR in the PACU. Sevoflurane was used for maintenance of anesthesia and all patients received 4 mg ondansetron one half hour before anesthesia emergence. PONV incidence was no different between groups. However, for the group whose IV solution contained dextrose, rescue medication dose for those who needed rescue antiemetic therapy was decreased by 40%, and length of PACU stay was reduced by 20%.
This study looked at a very conventional anesthetic: sevoflurane with ondansetron prophylaxis. Only secondary outcome measures showed benefit and the number of study participants was small. Nonetheless, there might be some benefit to the inclusion of dextrose in the maintenance intravenous solution used in the PACU.
It is interesting that virtually all studies that test a therapy to decrease PONV don’t include an anesthetic that minimizes PONV. Specifically, why isn’t propofol used in PONV studies for the maintenance of anesthesia? If the risk of PONV with propofol maintenance is so low that the efficacy of PONV prophylaxis can’t be studied, then why not just use propofol infusions?
The relationship between liberal use of perioperative fluids and PONV is also discussed in a section in OpenAnesthesia.