Effect Of Ondansetron On Prevention And Treatment Of Postoperative Nausea And Vomiting In Patients With Preoperative Anxiety

PartⅠEffect of Ondansetron on prevention and treatment of postoperative nausea and vomiting in patients with preoperative anxietyObjectives:To explore the effect of preoperative anxiety on postoperative nausea and vomiting,and to observe the effect of Ondansetron on postoperative nausea and vomiting in patients with preoperative anxiety.Methods:Patients who plan to undergo painless ovum were selected as the research subjects,with American society of Anesthesiologists(ASA)grading ranging from grade I to grade II,age ranging from 25 to 45 years old,and body mass index(BMI)ranging from 18.5 to 24 kg/m~2.Half an hour before surgery,patients were evaluated for preoperative anxiety using the Anxiety Self Rating Scale.Patients with scores ranging from 50 to 60 were included in the anxiety group,while patients with scores ranging from 25 to 35 were included in the non-anxiety group,with100 patients in each group.The anxiety group patients were randomly divided into two groups:ao and as,while the non-anxiety group patients were randomly divided into two groups:co and cs,with 50 patients in each group.15 minutes before operation,patients in the ao and co groups received intravenous injection of 8 mg(4 ml)of Ondansetron,while patients in the as and cs groups received saline of equal volume.All four groups of patients were treated with Propofol、Fentanyl intravenous anesthesia.Observe and record the mean arterial pressure,heart rate,pulse oxygen saturation and respiratory rate of patients at admission to the room(T1),completion of anesthesia induction(T2)and leaving the hospital(T3),preoperative conditions of patients,surgical conditions,postoperative nausea and vomiting and other adverse reactions 24 hours after surgery.Results:(1)Preoperative condition of patients:There was no statistically significant difference in age,BMI,ASA grade,smoking history,past postoperative nausea and vomiting history,motion sickness history,and preoperative fasting time among the four groups of patients(P>0.05).(2)Intraoperative vital signs:there was no significant difference in mean arterial pressure,heart rate,pulse oxygen saturation and respiratory rate at T1,T2 and T3 among the four groups(P>0.05).(3)Surgical situation:There was no statistically significant difference in the total amount of propofol and fentanyl used during surgery and the duration of surgery among the four groups(P>0.05).(4)Postoperative nausea and vomiting:There was no statistically significant difference in the incidence of grade I nausea and vomiting among the four groups of patients(P>0.05).The incidence of grade II nausea and vomiting in the as group(34%)was higher than that in the cs group(16%),and the incidence of grade II nausea and vomiting in the as group(34%)was higher than that in the ao group(8%)(P<0.05).The incidence of grade II nausea and vomiting in the co group(16%)was not significantly different from that in the cs group(16%)(P>0.05).None of the four groups of patients had grade III or IV nausea and vomiting.(5)Other adverse reactions after surgery:There was no statistically significant difference in the incidence of dizziness,drowsiness,and fatigue among the four groups of patients after surgery(P>0.05).Conclusions:Patients with preoperative anxiety are more likely to experience postoperative vomiting;Preoperative use of Ondansetron can effectively prevent and treat postoperative vomiting in patients with preoperative anxiety,but has no significant effect on postoperative nausea and vomiting in patients with non-anxiety.Part Ⅱ Mechanism of postoperative nausea and vomiting caused by preoperative anxietyObjectives:Explore the mechanism of preoperative anxiety leading to postoperative nausea and vomiting,and observe the role of 5-hydroxytryptamine(5-HT)in it.Methods:Patients who plant to undergo laparoscopic hysterectomy were selected as the research subjects,with ASA grading of I-III,age range of 40-70 years,and BMI of 18.5-24 kg/m2.On the day before surgery,the Anxiety Self Rating Scale was used to assess the anxiety level of patients.100 patients with scores ranging from 50 to 60 were included in the anxiety group,while 100 patients with scores ranging from 25 to 35 were included in the non-anxiety group.The anxiety group was randomly divided into AO and AS groups,while the non-anxiety group was randomly divided into CO and CS groups,with 50 cases in each group.2ml of venous blood was collected after the patient entered the room and three hours after the operation.After centrifugation,the serum was taken and frozen at-80 ℃,and the serum 5-hydroxytryptamine value was detected by enzyme-linked immunosorbent assay.15 minutes before anesthesia induction,Ondansetron 8mg(4ml)was injected intravenously in AO and CO groups,and the same volume of normal saline was given intravenously in AS and CS groups.Then general anesthesia was quickly induced,tracheal intubation was performed,and total intravenous anesthesia was maintained during the operation.After the operation,self-control intravenous analgesia pump was used to relieve postoperative pain.Observe and record: the average arterial pressure,heart rate,pulse oxygen saturation of patients at admission to the room(T1),pneumoperitoneum(T2),end of surgery(T3),10 minutes after extubation(T4),preoperative conditions,surgical conditions,postoperative nausea and vomiting and other adverse reactions48 hours after surgery.postoperative analgesia and conduct a patient satisfaction survey.Results:(1)Preoperative condition of patients: There was no statistically significant difference in age,BMI,ASA grade,smoking history,past postoperative nausea and vomiting history,motion sickness history,and preoperative fasting time among the four groups of patients(P>0.05).(2)Intraoperative vital signs: there was no significant difference in the mean arterial pressure,heart rate,and pulse oxygen saturation at T1,T2,T3,and T4 among the four groups(P>0.05).(3)Surgical situation : There was no significant difference in the total amount of Propofol,Remifentanil and Sufentanil,surgical duration,the amount of infusion and blood loss during the operation among the four groups(P>0.05).(4)Postoperative nausea and vomiting:There was no statistically significant difference in the incidence of grade I nausea and vomiting among the four groups of patients(P>0.05).The incidence of grade II nausea and vomiting in the AS group(34%)was higher than that in the CS group(22%),and the incidence of grade II nausea and vomiting in the AS group(34%)was higher than that in the AO group(6%)and the difference was statistically significant(P<0.05).There was no statistically significant difference in the incidence of grade II nausea and vomiting between the CO group(18%)and the CS group(22%)(P>0.05).None of the four groups of patients had grade III or IV nausea and vomiting.(5)Changes in serum 5-HT values: The preoperative and postoperative serum 5-HT levels of patients in the anxiety group were higher than those in the non-anxiety group(P<0.05),and there was no statistically significant difference in serum 5-HT values between the same group of patients before and after surgery(P>0.05).(6)Other adverse reactions after surgery : There was no statistically significant difference in postoperative chills,dizziness,and drowsiness among the four groups of patients(P>0.05).(7)Postoperative analgesia and patient satisfaction: There was no statistically significant difference in the number of postoperative analgesia pump presses and VAS scores among the four groups of patients(P>0.05).The satisfaction of patients in Group B was lower than that of the other three groups,and the difference was statistically significant(P<0.05).Conclusions:The serum 5-HT value of preoperative anxious patients was higher than that of non-anxious patients before and after surgery.Ondansetron may reduce the occurrence of postoperative vomiting in preoperative anxious patients by blocking the binding of 5-HT and anti 5-HT3 receptor.