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Muscular Tissue Oxygen Saturation and Posthysterectomy Nausea and Vomiting: The iMODIPONV Randomized Controlled Trial.

Publication ,  Journal Article
Li, G; Tian, D-D; Wang, X; Feng, X; Zhang, W; Bao, J; Wang, D-X; Ai, Y-Q; Liu, Y; Zhang, M; Xu, M; Mu, D-L; Zhao, X; Dai, F; Yang, J-J ...
Published in: Anesthesiology
August 2020

BACKGROUND: Suboptimal tissue perfusion and oxygenation during surgery may be responsible for postoperative nausea and vomiting in some patients. This trial tested the hypothesis that muscular tissue oxygen saturation-guided intraoperative care reduces postoperative nausea and vomiting. METHODS: This multicenter, pragmatic, patient- and assessor-blinded randomized controlled (1:1 ratio) trial was conducted from September 2018 to June 2019 at six teaching hospitals in four different cities in China. Nonsmoking women, 18 to 65 yr old, and having elective laparoscopic surgery involving hysterectomy (n = 800) were randomly assigned to receive either intraoperative muscular tissue oxygen saturation-guided care or usual care. The goal was to maintain muscular tissue oxygen saturation, measured at flank and on forearm, greater than baseline or 70%, whichever was higher. The primary outcome was 24-h postoperative nausea and vomiting. Secondary outcomes included nausea severity, quality of recovery, and 30-day morbidity and mortality. RESULTS: Of the 800 randomized patients (median age, 50 yr [range, 27 to 65]), 799 were assessed for the primary outcome. The below-goal muscular tissue oxygen saturation area under the curve was significantly smaller in patients receiving muscular tissue oxygen saturation-guided care (n = 400) than in those receiving usual care (n = 399; flank, 50 vs. 140% · min, P < 0.001; forearm, 53 vs. 245% · min, P < 0.001). The incidences of 24-h postoperative nausea and vomiting were 32% (127 of 400) in the muscular tissue oxygen saturation-guided care group and 36% (142 of 399) in the usual care group, which were not significantly different (risk ratio, 0.89; 95% CI, 0.73 to 1.08; P = 0.251). There were no significant between-group differences for secondary outcomes. No harm was observed throughout the study. CONCLUSIONS: In a relatively young and healthy female patient population, personalized, goal-directed, muscular tissue oxygen saturation-guided intraoperative care is effective in treating decreased muscular tissue oxygen saturation but does not reduce the incidence of 24-h posthysterectomy nausea and vomiting.

Duke Scholars

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Published In

Anesthesiology

DOI

EISSN

1528-1175

Publication Date

August 2020

Volume

133

Issue

2

Start / End Page

318 / 331

Location

United States

Related Subject Headings

  • Postoperative Nausea and Vomiting
  • Oxygen Consumption
  • Muscle, Skeletal
  • Middle Aged
  • Intraoperative Care
  • Hysterectomy
  • Humans
  • Female
  • Double-Blind Method
  • Anesthesiology
 

Citation

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Li, G., Tian, D.-D., Wang, X., Feng, X., Zhang, W., Bao, J., … iMODIPONV Research Group, . (2020). Muscular Tissue Oxygen Saturation and Posthysterectomy Nausea and Vomiting: The iMODIPONV Randomized Controlled Trial. Anesthesiology, 133(2), 318–331. https://doi.org/10.1097/ALN.0000000000003305
Li, Gang, Dan-Dan Tian, Xu Wang, Xiaoxian Feng, Wenyu Zhang, Ju Bao, Dong-Xin Wang, et al. “Muscular Tissue Oxygen Saturation and Posthysterectomy Nausea and Vomiting: The iMODIPONV Randomized Controlled Trial.Anesthesiology 133, no. 2 (August 2020): 318–31. https://doi.org/10.1097/ALN.0000000000003305.
Li G, Tian D-D, Wang X, Feng X, Zhang W, Bao J, et al. Muscular Tissue Oxygen Saturation and Posthysterectomy Nausea and Vomiting: The iMODIPONV Randomized Controlled Trial. Anesthesiology. 2020 Aug;133(2):318–31.
Li, Gang, et al. “Muscular Tissue Oxygen Saturation and Posthysterectomy Nausea and Vomiting: The iMODIPONV Randomized Controlled Trial.Anesthesiology, vol. 133, no. 2, Aug. 2020, pp. 318–31. Pubmed, doi:10.1097/ALN.0000000000003305.
Li G, Tian D-D, Wang X, Feng X, Zhang W, Bao J, Wang D-X, Ai Y-Q, Liu Y, Zhang M, Xu M, Mu D-L, Zhao X, Dai F, Yang J-J, Che X, Yanez D, Guo X, Meng L, iMODIPONV Research Group. Muscular Tissue Oxygen Saturation and Posthysterectomy Nausea and Vomiting: The iMODIPONV Randomized Controlled Trial. Anesthesiology. 2020 Aug;133(2):318–331.

Published In

Anesthesiology

DOI

EISSN

1528-1175

Publication Date

August 2020

Volume

133

Issue

2

Start / End Page

318 / 331

Location

United States

Related Subject Headings

  • Postoperative Nausea and Vomiting
  • Oxygen Consumption
  • Muscle, Skeletal
  • Middle Aged
  • Intraoperative Care
  • Hysterectomy
  • Humans
  • Female
  • Double-Blind Method
  • Anesthesiology