Supplemental intraoperative crystalloids for pediatric postoperative nausea and vomiting—A systematic review and meta‐analysis

Abstract

Background Postoperative nausea and/or vomiting is a relatively frequent occurrence after general anesthesia in pediatric patients. Supplemental perioperative crystalloid fluid administration has been shown to have a positive effect on the incidence of nausea and/or vomiting in adults undergoing surgery. The question arises whether supplemental intraoperative intravenous fluids in pediatric patients offers beneficial results with regards to pediatric postoperative nausea and/or vomiting. Methods Pubmed, EMBASE, Google Scholar, and Web of Science were searched up to March 2022 to perform a systematic review with meta‐analysis of randomized controlled trials involving patients ≤18 years undergoing elective surgery under general anesthesia, with one group receiving conventional intraoperative fluids therapy and the other group receiving supplemental intraoperative fluid therapy, with intravenous crystalloids. The outcomes included incidence of postoperative vomiting, postoperative nausea and vomiting, the need for rescue anti‐emetics, postoperative thirst, and adverse events attributed to supplemental intravenous fluid therapy. Relative risk (RR) with 95% confidence intervals (CIs) were reported for the outcomes using a random or fixed effects model. Results Seven randomized controlled trials (864 patients) were included in the final analysis. Supplemental intraoperative crystalloids reduce postoperative vomiting (RR 0.56, 95% CI 0.39–0.80; p = .001), postoperative nausea and vomiting (RR 0.52, 95% CI 0.37–0.74; p = .0003), postoperative thirst (RR 0.21, 95% CI 0.13,0.34; p < .01), and the need for rescue anti‐emetics postoperatively (RR 0.60, 95% CI 0.49–0.74; p = .00001). Conclusion Supplemental intraoperative intravenous crystalloids significantly reduce several PONV outcomes in healthy children undergoing relatively simple and superficial surgeries under volatile agent‐based general anesthesia.

Nausea and Vomiting After Posterior Spinal Fusion in Adolescent Idiopathic Scoliosis

“…Operative time is related to number of fusion levels or curve complexity, and evaluating its outcomes in current literature is challenging because of lack of a reporting standards in PSF surgery 56 . The role of intraoperative and postoperative blood loss and volume status on PONV rates is also in need of focused investigation 57-62 . In this review, intraoperative interventions such as dexamethasone and ketamine showed some reduction in PONV, however, lacked consistent findings to support their use 9,35-39 .…”

Prevalence and time course of postoperative nausea and vomiting and severe pain in patients under general anesthesia with patient-controlled intravenous analgesia

“…This study has limitations as follows: first, although this was a prospective study with data of the primary outcome from investigator follow-up, there were still some outcome data from anesthesia record sheets and electronic medical systems; therefore, confounding factors could not be effectively eliminated. Studies have revealed a negative correlation between intraoperative crystal infusion volume and the occurrence of PONV [ 16 ]. For laparoscopic cholecystectomy surgery, the incidence of PONV is lower at a high intraoperative crystal infusion rate (≥2 mL/kg/h) than at a lower infusion rate (<2 mL/kg/h) [ 17 ].…”

Relationship between preoperative fluid therapy and the occurrence of nausea and vomiting in post-spinal anesthetic patients

“…Alternatively, fluid therapy instead of fasting can also be formulated as 2cc/kgBW/hour of fasting (Gan et al 2019). According to Puri, Bandyopadhyay, and Ashok (2023), the daily fluid requirement can be determined using the Holiday Fresh formula, which replaces fluid lost through urine formation, gastrointestinal secretions, sweat, and expulsion of fluid through the lungs, also known as insensible losses.…”