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Meta-Analysis
. 2019 Mar 29;3(3):CD012212.
doi: 10.1002/14651858.CD012212.pub2.

Supplemental perioperative intravenous crystalloids for postoperative nausea and vomiting

James K Jewer  1 , Michael J Wong, Sally J Bird, Ashraf S Habib, Robin Parker, Ronald B George
Affiliations
Meta-Analysis

Supplemental perioperative intravenous crystalloids for postoperative nausea and vomiting

James K Jewer et al. Cochrane Database Syst Rev. .

Abstract

Background: Postoperative nausea and vomiting (PONV) is a common complication following general anaesthesia. It may be associated with patient dissatisfaction, increased costs of treatment, and unintended admission to hospital.Supplemental intravenous crystalloid administration in the perioperative period may be a simple intervention to prevent PONV.

Objectives: To assess whether supplemental intravenous crystalloid administration prevents PONV in patients undergoing surgical procedures under general anaesthesia.

Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 7), MEDLINE (1946 to August 2018), Embase (1947 to August 2018), and the Cumulative Index of Nursing and Allied Health Literature (CINAHL; 1971 to August 2018). We searched clinical trials registers for ongoing or unpublished completed studies (August 2018), handsearched three major journals (British Journal of Anaesthesia, European Journal of Anaesthesiology, and Anesthesiology; August 2018), and conducted backward and forward citation searching of relevant articles.

Selection criteria: We included randomized controlled trials of participants older than six months undergoing surgical procedures under general anaesthesia and given supplemental perioperative intravenous crystalloids, defined as a volume larger than that received by a comparator group, to prevent PONV.

Data collection and analysis: We used the standard methodological procedures described by Cochrane.

Main results: We included 41 studies (4224 participants). Participants underwent ambulatory or short length of stay surgical procedures, and were predominantly American Society of Anesthesiology (ASA) class I or II. There is one study awaiting classification and three ongoing studies. All studies took place in surgical centres, and were conducted in geographically diverse settings. Risk of bias was generally unclear across all domains.Supplemental intravenous crystalloid administration probably reduces the cumulative risk of postoperative nausea (PON) (risk ratio (RR) 0.62, 95% confidence interval (CI) 0.51 to 0.75; 18 studies; 1766 participants; moderate-certainty evidence). When the postoperative period was divided into early (first six hours postoperatively) and late (at the time point closest to or including 24 hours postoperatively) time points, the intervention reduced the risk of early PON (RR 0.67, 95% CI 0.58 to 0.78; 20 studies; 2310 participants; moderate-certainty evidence) and late PON (RR 0.47, 95% CI 0.32 to 0.69; 17 studies; 1682 participants; moderate-certainty evidence).Supplemental intravenous crystalloid administration probably reduces the risk of postoperative vomiting (POV) (RR 0.50, 95% CI 0.40 to 0.63; 20 studies; 1970 participants; moderate-certainty evidence). The intervention specifically reduced both early POV (RR 0.56, 95% CI 0.41 to 0.76; 19 studies; 1998 participants; moderate-certainty evidence) and late POV (RR 0.48, 95% CI 0.29 to 0.79; 15 studies; 1403 participants; moderate-certainty evidence).Supplemental intravenous crystalloid administration probably reduces the need for pharmacologic treatment of PONV (RR 0.62, 95% CI 0.51 to 0.76; 23 studies; 2416 participants; moderate-certainty evidence).The effect of supplemental intravenous crystalloid administration on the risk of unplanned postoperative admission to hospital is unclear (RR 1.05, 95% CI 0.77 to 1.43; 3 studies; 235 participants; low-certainty evidence).No studies reported serious adverse events that may occur following supplemental perioperative intravenous crystalloid administration (i.e. admission to high-dependency unit, postoperative cardiac or respiratory complication, or death).

Authors' conclusions: There is moderate-certainty evidence that supplemental perioperative intravenous crystalloid administration reduces PON and POV, in ASA class I to II patients receiving general anaesthesia for ambulatory or short length of stay surgical procedures. The intervention probably also reduces the risk of pharmacologic treatment for PONV. The effect of the intervention on the risk of unintended postoperative admission to hospital is unclear. The risk of serious adverse events resulting from supplemental perioperative intravenous crystalloid administration is unknown as no studies reported this outcome. The one study awaiting classification may alter the conclusions of the review once assessed.

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Conflict of interest statement

James K Jewer: no conflict of interest to disclose.

Michael J Wong: no conflict of interest to disclose.

Robin Parker: no conflict of interest to disclose.

Sally J Bird: no conflict of interest to disclose.

Ashraf S Habib received research support from Acacia Pharma (2015 to 2016) and was an advisory board member for Mylan (2014) and Baxter (2015). He has a grant pending from Trevena Inc (2016 to 2017). None of those entities produce the intervention of interest except for Baxter, which manufactures intravenous fluids. Acacia and Baxter are pharmaceutical companies that manufacture antiemetics for the management of PONV, but antiemetic medications are not the intervention of interest in this review. The advisory board relationship with Baxter was not related to intravenous fluids.

Ronald B George: no conflict of interest to disclose.

Figures

1
1
Study flow diagram.
2
2
'Risk of bias' graph.
3
3
'Risk of bias' summary.
4
4
Forest plot of comparison: 1 Supplemental IV crystalloid administration for preventing PONV versus control, outcome: 1.5 Risk of overall PON (when cumulative nausea events were explicitly reported for the entire study period), as measured by the presence of subjective nausea, reported dichotomously or based on a study‐defined dichotomous threshold on a continuous scale such as a VAS.
5
5
Forest plot of comparison: 1 Supplemental IV crystalloid administration for preventing PONV versus control, outcome: 1.9 Risk of pharmacologic treatment for PONV.
6
6
Forest plot of comparison: 1 Supplemental IV crystalloid administration for preventing PONV versus control, outcome: 1.6 Risk of cumulative POV.
1.1
1.1. Analysis
Comparison 1 Supplemental IV crystalloid administration for preventing PONV versus control, Outcome 1 Risk of cumulative PON.
1.2
1.2. Analysis
Comparison 1 Supplemental IV crystalloid administration for preventing PONV versus control, Outcome 2 Risk of early PON.
1.3
1.3. Analysis
Comparison 1 Supplemental IV crystalloid administration for preventing PONV versus control, Outcome 3 Risk of late PON.
1.4
1.4. Analysis
Comparison 1 Supplemental IV crystalloid administration for preventing PONV versus control, Outcome 4 Risk of early PON, reported as a continuous outcome.
1.5
1.5. Analysis
Comparison 1 Supplemental IV crystalloid administration for preventing PONV versus control, Outcome 5 Risk of late PON reported as a continuous outcome.
1.6
1.6. Analysis
Comparison 1 Supplemental IV crystalloid administration for preventing PONV versus control, Outcome 6 Risk of cumulative POV.
1.7
1.7. Analysis
Comparison 1 Supplemental IV crystalloid administration for preventing PONV versus control, Outcome 7 Risk of early POV.
1.8
1.8. Analysis
Comparison 1 Supplemental IV crystalloid administration for preventing PONV versus control, Outcome 8 Risk of late POV.
1.9
1.9. Analysis
Comparison 1 Supplemental IV crystalloid administration for preventing PONV versus control, Outcome 9 Risk of pharmacologic treatment for PONV.
1.10
1.10. Analysis
Comparison 1 Supplemental IV crystalloid administration for preventing PONV versus control, Outcome 10 Risk of unintended postoperative admission to hospital.
See this image and copyright information in PMC

Update of

References

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References to studies excluded from this review

Abraham‐Nording 2012 {published data only}
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References to studies awaiting assessment

Laws 2003 {published data only}
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References to ongoing studies

NCT03141645 {published data only}
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NCT03142464 {published data only}
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NCT03485443 {published data only}
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References to other published versions of this review

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