デイサージャリー診療部でのremifentanil使用とPONV

以前研修をしていて今は京都医療センターにいる原先生の論文がKorean Journal of anesthesiologyにアクセプトされました。

The impact of remifentanil on incidence and severity of postoperative nausea and vomiting in a university hospital-based ambulatory surgery center: a retrospective observation study

Abstract

Background: Ambulatory surgery, including short-stay surgery, has become a common choice of clinical practice. For the success of ambulatory surgery, perioperative care with safe and effective anesthesia and postoperative analgesia, which can reduce the occurrence of postoperative nausea and vomiting (PONV), is essential. The effect of remifentanil on the occurrence and severity of PONV has not been thoroughly examined, particularly, in an ambulatory surgery setting. We investigated whether remifentanil influenced the occurrence and severity of PONV in a university hospital-based ambulatory unit.

Methods: We retrospectively analyzed a total of 1765 cases of patients who had undergone general anesthesia at our ambulatory surgery unit. Parameters such as occurrence and severity of nausea, vomiting or retching, use of antiemetic drugs, amount of postoperative analgesic and patient satisfaction were extracted from the records and analyzed between the groups that was administered remifentanil (RF group) and that was not administered remifentanil (non RF group).

Results: Within 565 patients of the RF group, 39 patients (6.6%) experienced nausea, 7 patients (1.2%) experienced vomiting or retching, 10 patients (1.8%) were given antiemetic, and the maximum VAS value for nausea was 12.1mm. In 1200 patients of the non RF group, 102 patients (8.5%) experienced nausea, 19 patients (1.6%) experienced vomiting or retching, 34 patients (2.8%) were given antiemetic and the maximum VAS value was 13.2 mm. There were no statistically significant differences between the two groups.

Conclusions: Our results indicate that remifentanil did not increase the occurrence of PONV in patients in the ambulatory surgery unit.

Keywords: Ambulatory surgery, Post operative nausea and vomiting, Remifentanil

 

要するに鎮痛がしっかりしていれば術中にremifentanilを用いてもPONVの比率は上がらないし、術後の鎮痛剤の要求度も上がらないという研究です。 KJAは雑誌の掲載が遅いのでまだ読むことはできません。

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