ABSTRACT
Objective To study the risk factors for postoperative nausea and vomiting (PONV) in gynecological patients administered prophylactic antiemetics.Methods A total of 1 000 gynecological surgical cases were reviewed.Data on patient characteristics,anesthesia,surgeries,and 1st postoperative day nausea and vomiting were collected and analyzed statistically.Results Multivariate logistic regression analysis included a history of motion sickness,the use of an analgesic pump,the duration of anesthesia,and the use of neostigmine.The odds ratios (ORs),in decreasing order,were that of a history of motion sickness [OR =1.953,95％ confidence interval (CI):1.404-2.716],the use of neostigmine (OR =1.831,95％ CI:1.203-2.786),the use of an analgesic pump (OR =1.472,95％ CI:1.017-2.129),and the duration of anesthesia (OR =1.256,95％ CI:1.058-1.492).The predictive model was described by the following equation:P=1/(1+e(1623-0.669X1-0.386X2-0.228X3+0.605X4)).Tne predictive accuracy of this model for the incidence of PONV in gynecological patients was 70.6％,and the area under the receiver operating characteristic curve for the predictive result was 0.642.Conclusion The independent risk factors for PONV in gynecological patients administered prophylactic antiemetics are a history of motion sickness,the use of neostigmine,the use of an analgesic pump,and the duration of anesthesia,in decreasing order of significance.
ABSTRACT
Objective To evaluate and compare the effectiveness of propofol-remifentanil closed-loop and open-loop anesthesia in gynecological laparoscopic operation under bispectral index (BIS) monitoring.Methods Forty female patients undergoing elective gynecological laparoscopic operation were recruited and randomly divided into closed-loop (group Ⅰ) and open-loop (group Ⅱ) groups.During anesthesia maintenance,the closed-loop group was administered with a BIS-feedback system to regulate the target effect-site concentration;whereas,the open-loop group was administered the target effect-site concentration according BIS value manually.The variation of non-invasive mean arterial pressure (MAP),heart rate (HR),SpO2,BIS,extubation time,consumption of propofol and remifentanil,Ramsay index,and subjective comfort grade were recorded at the selected time points.Results The extubation time in group Ⅰ was shorter than in group Ⅱ.The total dosage of propofol administered in group Ⅰ was less than that in group Ⅱ,but there was no significant difference in the total consumption of remifentanil.HR in group Ⅰ was steadier than in group Ⅱ.However,the MAP and Ramsay index were similar in both the groups.The subjective comfort grade in group Ⅰ was higher than in group Ⅱ.Conclusion The use of propofol-remifentanil closed-loop system by BIS-feedback anesthesia is safer,more controllable,with higher degree of satisfaction and sparing side-effects,we therefore recommend it during gynecological laparoscopic operations.