ABSTRACT
ABSTRACT BACKGROUND: Postoperative nausea and vomiting (PONV) is a common complication from general anesthesia that impacts on postoperative recovery. OBJECTIVE: To evaluate prophylactic rewarming following general anesthesia, so as to decrease the incidence of PONV among patients undergoing laparoscopic hysterectomy. DESIGN AND SETTING: Prospective randomized clinical study at a hospital in China. METHODS: Sixty-two patients were randomly assigned into two groups. The forced air warming (FAW) group received pre-warmed Ringer's solution with FAW until the end of surgery. The control group received Ringer's solution without FAW. The pre-warmed Ringer's solution was stored in a cabinet set at 40 °C. The FAW tube was placed beside the patient's shoulder with a temperature of 43 °C. RESULTS: Sixty patients completed the study. The FAW group showed significant differences versus the controls regarding temperature. At 6, 24 and 48 hours postoperatively, the incidences of PONV were 53.3%, 6.7% and 3.3% in the FAW group versus 63.3%, 30% and 3.3% in the controls. VAS scores were significantly lower in the FAW group than in the controls at 24 hours (P= 0.035). Forty-item questionnaire total scores in the FAW group were significantly higher than in the controls. The physical independence and pain scores at 24 hours and emotional support and pain scores at 48 hours in the FAW group were higher than in the controls (P < 0.05). There was no difference in hemodynamics or demographics between the two groups (P > 0.05). CONCLUSIONS: Prophylactic rewarming relieved PONV and improved the quality of postoperative recovery. CHINESE CLINICAL TRIAL REGISTER (ChiCTR): ChiCTR-IOR-17012901.
Subject(s)
Humans , Female , Laparoscopy/adverse effects , Rewarming , Postoperative Nausea and Vomiting/prevention & control , Hysterectomy/adverse effects , Hysterectomy/methods , China , Prospective Studies , Treatment OutcomeABSTRACT
Abstract Background: QoR-40, a 40-item questionnaire on quality of recovery from anaesthesia, has been shown to measure health status after surgery. Our aim was to evaluate the incidence of poor quality of recovery in our Post Anaesthesia Care Unit and to compare their QoR-40 scores before surgery and 3 months later. Methods: A prospective observational study was conducted in adult patients consecutively admitted from 18 June to 12 July 2012. The follow-up period was 3 months. We exclude patients submitted to cardiac surgery, neurosurgery, obstetric surgery and with a mini-mental state examination test score lower than 25. The primary endpoint was quality of recovery measured with the validated Portuguese for Portugal version of the QoR-40 before surgery (T0), 24 h after surgery (T1) and 3 months after (T2). Results: A total of 114 patients completed the study. Mean QoR-40 score was 169 and patients with poor quality of recovery were identified if their QoR-40 score was lesser than 142. This occurred in 26 patients (24%). Global median scores for patients with poor quality of recovery were lower at T0 (121 vs. 184, p < 0.001), at T1 (120 vs. 177, p < 0.001) and at T2 (119 vs. 189, p < 0.001). Conclusion: Patients with poor quality of recovery had lower quality of life. This fact may allow earlier and more effective interventions, in order to improve quality of life after surgery. Beside its utility after surgery, QoR-40 may be important prior to surgery to identify patients who will develop a poor quality of recovery.
Resumo Justificativa: QoR-40, um questionário com 40 itens sobre a qualidade de recuperação da anestesia, mostrou medir o estado de saúde após a cirurgia. O nosso objetivo foi avaliar a incidência de má qualidade da recuperação em nossa Sala de Recuperação Pós-Anestesia e comparar os escores do QoR-40 antes e três meses depois da cirurgia. Métodos: Estudo observacional prospectivo, feito com pacientes adultos admitidos consecutivamente de 18 de junho a 12 de julho de 2012. O período de acompanhamento foi de três meses. Excluímos os pacientes submetidos a cirurgia cardíaca, neurocirurgia, cirurgia obstétrica e aqueles com escore inferior a 25 no miniexame do estado mental. O desfecho primário foi a qualidade da recuperação medida com a versão do QoR-40, validada para a versão do português de Portugal, antes da cirurgia (T0), 24 horas após a cirurgia (T1) e três meses após a cirurgia (T2). Resultados: No total, 114 pacientes completaram o estudo. A média dos escores no QoR-40 foi de 169 e os pacientes com má qualidade de recuperação foram identificados se os seus escores no QoR-40 fossem menores do que 142. Isso ocorreu em 26 pacientes (24%). As médias dos escores globais dos pacientes com má qualidade de recuperação foram menores em T0 (121 vs. 184, p < 0,001), T1 (120 vs. 177, p < 0,001) e T2 (119 vs. 189, p < 0,001). Conclusão: Os pacientes com má qualidade de recuperação apresentaram uma pior qualidade de vida. Esse fato pode permitir intervenções precoces e mais eficazes para melhorar a qualidade de vida após a cirurgia. Além de sua utilidade após a cirurgia, o QoR-40 pode ser importante antes da cirurgia para identificar os pacientes que desenvolverão uma má qualidade de recuperação.