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Supplemental peri-operative intravenous crystalloids for postoperative nausea and vomiting: an abridged Cochrane systematic review.

Authors
  • Jewer, J K1
  • Wong, M J1
  • Bird, S J1
  • Habib, A S2
  • Parker, R3
  • George, R B4
  • 1 Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada. , (Canada)
  • 2 Duke University Medical Center, Durham, NC, USA.
  • 3 W.K. Kellogg Health Sciences Library, Dalhousie University, Halifax, NS, Canada. , (Canada)
  • 4 Department of Anaesthesia and Perioperative Care, University of California, San Francisco, CA, USA.
Type
Published Article
Journal
Anaesthesia
Publisher
Wiley (Blackwell Publishing)
Publication Date
Feb 01, 2020
Volume
75
Issue
2
Pages
254–265
Identifiers
DOI: 10.1111/anae.14857
PMID: 31536172
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

We conducted a Cochrane systematic review on the effectiveness of supplemental intravenous crystalloid administration in preventing postoperative nausea and vomiting. We included randomised controlled trials of patients undergoing surgery under general anaesthesia and given supplemental peri-operative intravenous crystalloid. Our primary outcomes were the risk of postoperative nausea and the risk of postoperative vomiting. We assessed the risk of bias for each included study and applied the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework for the certainty of evidence. We included 41 studies. We found that the intervention probably reduces the overall risk of postoperative nausea, the risk ratio (95%CI) being 0.62 (0.51-0.75) (I2 = 57%, p < 0.00001, 18 studies; 1766 participants; moderate-certainty evidence). It also probably reduces the risk of postoperative nausea within 6 h of surgery, with a risk ratio (95%CI) of 0.67 (0.58 to 0.78) (I2 = 9%, p < 0.00001, 20 studies; 2310 participants; moderate-certainty evidence) and by around 24 h, the risk ratio (95%CI) being 0.47 (0.32-0.69) (I2 = 38%, p = 0.0001, 17 studies; 1682 participants; moderate-certainty evidence). Supplemental intravenous crystalloid probably also reduces the overall risk of postoperative vomiting, with a risk ratio (95%CI) of 0.50 (0.40-0.63) (I2 = 31%, p < 0.00001, 20 studies; 1970 participants; moderate-certainty evidence). The beneficial effect on vomiting was seen both within 6 h and by around 24 h postoperatively. © 2019 Association of Anaesthetists.

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