Is the reduced risk of post-operative nausea and vomiting in low flow anesthesia applications associated with pre-operative neutrophil/lymphocyte ratio values?

PONV risk in low flow anesthesia applications

Authors

Keywords:

postoperative nausea and vomiting, low fresh gas flow, neutrophil-lymphocyte ratio

Abstract

Background/Aim: Post-operative nausea and vomiting (PONV) are defined as nausea and/or vomiting occurring within the first 24 h after surgery and are often observed in the first 2 h after surgery. Only a few previous studies on the use of low fresh gas flow that reduces inhaler agent consumption in laparoscopic cholecystectomy patients at high risk of PONV have been published. Our study aimed to determine the incidence of PONV in the first 30 min and again at 24 h in cases of laparoscopic cholecystectomy in which we applied low fresh gas flow (1 L/min). In addition, we wanted to predict whether the pre-operative neutrophil/lymphocyte ratio (NLR) ≥2 is a risk factor for PONV in our patients to whom we applied low fresh gas flow.

Methods: For our prospective cohort study, 80 cases between the ages of 18 and 65, had American Society of Anesthesiologists (ASA) scores of I and II, and who had been scheduled to undergo elective laparoscopic cholecystectomy were included in the study. The NLR limit (calculated by dividing the neutrophil count obtained from the complete blood count before surgery by the lymphocyte count) calculated in the pre-operative period after a patient’s informed consent was obtained was accepted as 2 [5]. Patients were classified into two groups: (1) NLR-I with NLR <2 and (2) NLR-II with NLR ≥2. Premedication was not used in either group.

Results: A total of 80 patients were included in the study. They were divided into two groups for classification purposes: (1) NLR-I (n=40) and (2) NLR-II (n=40). The characteristics of the patients in both groups, such as gender distribution, ASA scores, smoking status, mean age, and body mass index (BMI) values, were not different. Sevoflurane consumption in the groups was similar (P=0.169). The time required to complete surgery was longer in the NLR-II group (P=0.025). Nausea/vomiting and antiemetic use were similar in the NLR-I and NLR-II groups in which low fresh gas flow was applied in the first 30 min and 24 h (P=0.500). Although nausea/vomiting was more common in the female and non-smoking group in the first 30 min and 24 h, it was not statistically significantly different from males and smoking groups (P=0.325). However, nausea/vomiting was more common and significantly different in the ASA II versus the ASA I group (P=0.046). The time required to complete surgery was longer, and sevoflurane consumption was higher in patients with nausea and vomiting (P=0.001).

Conclusions: Pre-operative NLR as classified by the two groups was not associated with an increase in the risk of PONV in patients to whom we applied low fresh gas flow. A decrease in sevoflurane consumption due to low fresh gas flow may lead to a reduction in the risk of PONV in at-risk patients.

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References

Zengin M, Sazak H, Baldemir R, Ulger G, Aydemir S, Acar LN, et al. Parameters Affecting Nausea and Vomiting After Thoracoscopic Wedge Resection in Patients With Pneumothorax. Cureus. 2021;13(11):e19926. DOI: https://doi.org/10.7759/cureus.19926

Tahir S, Mir AA, Hameed A. Comparison of Palonosetron with Granisetron for Prevention of Postoperative Nausea and Vomiting in Patients Undergoing Laparoscopic Abdominal Surgery. Anesth Essays Res. 2018;12(3):636–43. DOI: https://doi.org/10.4103/aer.AER_84_18

Apfel CC, Heidrich FM, Jukar-Rao S, Jalota L, Hornuss C, Whelan RP, et al. Evidence-based analysis of risk factors for postoperative nausea and vomiting. Br J Anaesth. 2012;109(5):742-53. DOI: https://doi.org/10.1093/bja/aes276

Karaca O, Dogan G. Can Neutrophil-to-Lymphocyte or Platelet-to-Lymphocyte Ratio Be Used to Predict Postoperative Nausea and Vomiting in Breast Reduction? Cureus. 2020;12(3):e7237. DOI: https://doi.org/10.7759/cureus.7237

Qin B, Ma N, Tang Q, Wei T, Yang M, Fu H, et al. Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) were useful markers in assessment of inflammatory response and disease activity in SLE patients. Mod Rheumatol. 2016;26(3):372-6. DOI: https://doi.org/10.3109/14397595.2015.1091136

Yildiz Altun A, Demirel İ, Bolat E, Özcan S, Altun S, Aksu A, et al. The Relationship Between the Preoperative Neutrophil-to-Lymphocyte Ratio and Postoperative Nausea and Vomiting in Patients Undergoing Septorhinoplasty Surgery. Aesthetic Plast Surg. 2019;43(3):861-5. DOI: https://doi.org/10.1007/s00266-019-01325-5

Elhakim M, Nafie M, Mahmoud K, Atef A. Dexamethasone 8 mg in combination with ondansetron 4 mg appears to be the optimal dose for the prevention of nausea and vomiting after laparoscopic cholecystectomy. Can J Anaesth. 2002;49(9):922-8. DOI: https://doi.org/10.1007/BF03016875

Habib AS, Gan TJ. Combination therapy for postoperative nausea and vomiting – a more effective prophylaxis? Ambulatory Surgery. 2001;9:59–71. DOI: https://doi.org/10.1016/S0966-6532(01)00103-2

Habib AS, Gan TJ. Combination antiemetic. What is the evidence? Int Anesthesiol Clin Fall 2003;41:119–44. DOI: https://doi.org/10.1097/00004311-200341040-00010

Apfel CC, Laara E, Koivuranta M, Greim CA, Roewer N. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Anesthesiology. 1999;91:693-700. DOI: https://doi.org/10.1097/00000542-199909000-00022

Fujii Y. The utility of antiemetics in the prevention and treatment of postoperative nausea and vomiting in patients scheduled for laparoscopic cholecystectomy. Curr Pharm Des. 2005;11(24):3173-83. DOI: https://doi.org/10.2174/1381612054864911

Apfel CC, Korttila K, Abdalla M, Kerger H, Turan A, Vedder I, et al; IMPACT Investigators. A factorial trial of six interventions for the prevention of postoperative nausea and vomiting. N Engl J Med. 2004 Jun 10;350(24):2441-51. DOI: https://doi.org/10.1056/NEJMoa032196

Erhan Y, Erhan E, Aydede H, Yumus O, Yentur A. Ondansetron, granisetron, and dexamethasone compared for the prevention of postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy: A randomized placebo-controlled study. Surg Endosc. 2008;22(6):1487-92. DOI: https://doi.org/10.1007/s00464-007-9656-3

Apfel CC, Kranke P, Katz MH, Goepfert C, Papenfuss T, Rauch S, et al. Volatile anaesthetics may be the main cause of early but not delayed postoperative vomiting: a randomized controlled trial of factorial design. Br J Anaesth. 2002;88(5):659-68. DOI: https://doi.org/10.1093/bja/88.5.659

Apfel CC, Stoecklein K, Lipfert P. PONV: a problem of inhalational anaesthesia? Best Pract Res Clin Anaesthesiol. 2005;19(3):485-500. DOI: https://doi.org/10.1016/j.bpa.2005.03.001

Nelskyla KA, Yli-Hankala AM, Puro PH, Korttila KT. Sevoflurane titration using bispectral index decreases postoperative vomiting in phase II recovery after ambulatory surgery. Anesth Analg. 2001;93(5):1165-9. DOI: https://doi.org/10.1097/00000539-200111000-00021

Taylor E, Feinstein R, White PF, Soper N. Anesthesia for laparoscopic cholecystectomy. Is nitrous oxide contraindicated? Anesthesiology. 1992;76(4):541-4. DOI: https://doi.org/10.1097/00000542-199204000-00009

Peyton PJ, Wu CY. Nitrous oxide-related postoperative nausea and vomiting depends on duration of exposure. Anesthesiology. 2014;120(5):1137-45. DOI: https://doi.org/10.1097/ALN.0000000000000122

Gan TJ, Belani KG, Bergese S, Chung F, Diemunsch P, Habib AS, et al. Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting. Anesth Analg. 2020;131(2):411-48. DOI: https://doi.org/10.1213/ANE.0000000000004833

Oyama T, Kinoshita H, Takekawa D, Saito J, Kushikata T, Hirota K. Higher neutrophil-to-lymphocyte ratio, mean platelet volume, and platelet distribution width are associated with postoperative delirium in patients undergoing esophagectomy: a retrospective observational study. J Anesth. 2022;36(1):58-67. DOI: https://doi.org/10.1007/s00540-021-03007-6

Shimoyama Y, Umegaki O, Agui T, Kadono N, Minami T. Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio are superior to other inflammation-based prognostic scores in predicting the mortality of patients with gastrointestinal perforation. JA Clin Rep. 2017;3(1):49-54. DOI: https://doi.org/10.1186/s40981-017-0118-1

Arpaci AH, Işik B, Ilhan E, Erdem E. Association of Postoperative Nausea-Vomiting (PONV) Incidence with Neutrophil-Lymphocyte Ratio (NLR) in Ambulatory Maxillofacial Surgeries. Journal of Oral and Maxillofacial Surgery. 2017;75(7):1367-71. DOI: https://doi.org/10.1016/j.joms.2016.12.036

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Published

2023-09-10

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Research Article

How to Cite

1.
Kutlusoy S, Aydın A, Koca E. Is the reduced risk of post-operative nausea and vomiting in low flow anesthesia applications associated with pre-operative neutrophil/lymphocyte ratio values? PONV risk in low flow anesthesia applications. J Surg Med [Internet]. 2023 Sep. 10 [cited 2024 Jul. 3];7(9):555-9. Available from: https://jsurgmed.com/article/view/7889