Studies have shown the incidence of postoperative nausea and vomiting (PONV) in patients undergoing bariatric surgeries was very high in spite of pharmacological prophylaxis or adjustment of anesthetics.Nevertheless, evidence has indicated goal-directed fluid therapy (GDFT) improves outcomes including PONV in major abdominal surgeries. The aim of our study is to investigate the effect of GDFT on reducing the incidence of PONV in patients undergoing laparoscopic sleeve gastrectomy (LSG).
Twenty-one bariatric patients undergoing LSG were randomly assigned into two groups in this prospectively pilot study. All patients received general anesthesia following consistent anesthesia protocol. In the treatment group (n=10), stroke volume variation (SVV)-based GDFT with crystalloid was utilized. In
the control group (n=11), weight-based fluid management as routine perioperative care was applied. PONV was evaluated by a standardized questionnaire at 1h, 24h and 48h after the surgery.
The baseline characteristics and comorbidities between the two groups of patients were similar. There was no significant difference in intraoperative infused fluid between GDFT group and control group (1633±381 vs. 1699.3±314.7 ml). The PONV data at post-op 1h, 24h and 48h showed no significant reduction in the
incidence of PONV in GDFT group compared with control group (5/10 vs. 5/11, 6/10 vs. 4/11, and 1/10 vs. 2/11, respectively).
The GDFT group did not represent obvious intraoperatively infused volume difference compared with the control group. It was speculated that LSG is a relatively hemodynamically-stable surgery without massive hemorrhage or intravascular volume shifting. The surgical duration is usually 2~3 hours. Weight-based fluid strategy would not easily diverge adequate intraoperative volume. In addition, using crystalloid as a fluid challenge option to achieve the setting cut-off of GDFT (SVV<10%) would expand the demand of intraoperative fluid compared to colloid.
In conclusion, there was no significant effect of GDFT with crystalloid on reducing the incidence of PONV in patients undergoing laparoscopic sleeve gastrectomy (LSG). The effect of GDFT with other types of fluid to reduce PONV should be further investigated and determined.


09 / Post-operative nausea and vomiting in bariatric patients undergoing laparoscopic sleeve gastrectomy.