The Effects Of Preoperative Psychological Status And Hormone Levels On The Incidence Of Postoperative Nausea And Vomiting Following Gynecological Laparoscopic Surgery

Objectives:Postoperative nausea and vomiting (PONV) is the most common postoperative complication after surgery.The incidence of PONV ranged from20%-40%after general anesthesia surgery. There are many risk factors on the incidence of PONV after gynecological laparoscopic surgery, such as female gender, no smoking history, laparoscopic surgery, gynecologic surgery, and so on. Studies have shown that the incidence of PONV is as high as50.0%-88.2%after gynecological laparoscopic surgery. It is unknown whether the occurrence of PONV is associated with the preoperative psychological status or hormone levels. We analyze the possible risk factors of PONV after gynecological laparoscopic surgery, particularly the preoperative psychological status and reproductive hormone levels, in order to prevent and treat PONV.Methods:101cases female patients who underwent gynecological laparoscopic surgery at Hangzhou first people’s hospital and affiliated hospital of Zhejiang tradional Chinese Medicine medical university between September2009-March2010were enrolled prospectively. Age, smoking, history of motion sickness, narcotic drugs (fentanyl dosage), antiemetic drugs, inhaled anesthesia drugs, airway, the depth of anesthesia and surgery time were recorded. Self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were used to assess the preoperative psychological state. We measured the blood serum level of follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), estradiol (E2), progesterone (P), testosterone (T) on the day before surgery. Visual analog scale nausea (NVAS) was used to evaluate the occurence of PONY within the postoperative24hours. According to NVAS score, patients were divided into PONV group and Non-PONV group. Statistical analysis was carried out using SPSS (version14.0.1, SPSS Inc., Chicago, IL, USA).Results:There were no intraoperative hypotension, delayed recovery, and other serious postoperative complications in101patients during surgery.92patients completed the preoperative determination of reproductive hormone levels, and72patients completed the preoperative assessment of SAS and SDS.(1)46patients had postoperative nausea and vomiting (PONV) within24hours after gynecological laparoscopic surgery, while55patients had no postoperative nausea and vomiting (Non-PONV). The incidence of PONV was45.5%.(2) The standard score of self-rating anxiety scale (SAS)(49.14±8.01) in PONV group was significantly higher than that in Non-PONV group (44.54±7.58)(P<0.05). The patients with anxiety (SAS>50) accounted for57%in PONV group, while30%in Non-PONV group. After a chi-square test, there is a much more cases with preoperative anxiety in PONV group, compared with that in Non-PONV group (χ2=5.513, P<0.05). It showed that the occurence of PONV was positively correlated with preoperative anxiety using correlational analyses (r=0.277, P<0.05).(3) There was no statistically significant difference in the standard scores of self-rating depression scale (SDS) between PONV group (41.29±11.25) and Non-PONV group (39.54±8.75)(P>0.05). No correlation was found between the occurrence of PONV and preoperative depression (P>0.05).(4) There was no statistically significant difference in the serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), estradiol (E2), progesterone (P), testosterone (T), the ratio of estradiol and progesterone, the ratio of estradiol and testosterone between PONV group and Non-PONV group (P>0.05).(5) The mean age in PONV group (42.91±10.90y) was older than that in Non-PONV group (38.05±10.23y)(t=2.307, P<0.05). Correlation analysis showed the occurence of PONV was positively correlated with age (r=0.204, P<0.05).(6) There was no statistically significant difference in the operative time, type of surgery, smoking history, history of motion sickness, inhaled drugs (the ratio of isoflurane and sevoflurane), airway (the ratio of laryngeal mask and endotracheal tube) between PONV group and the Non-PONV group (P>0.05).Conclusions:(1) Preoperative anxiety was positively correlated with the occurrence of PONV. Higher level of anxiety before surgery may increase the risk of postoperative nausea and vomiting. Whereas, no correlation was found between the occurence of PONV and preoperative depression.(2) No correlation was found between the occurrence of PONV and the level of the reproductive hormones.(3) Age might be a high risk factor of PONV.(4) There was no correlation between the occurence of PONV and the operative time, type of surgery, smoking history, history of motion sickness, inhaled drugs (the ratio of isoflurane and sevoflurane) or airway (the ratio of laryngeal mask and endotracheal tube).Based on the findings, the patients undergoing gynecological aparoscopic surgery should reduce the level of anxiety with appropriate psychological counseling or prophylactic anti-anxiety drugs. The effect of age, hormone and menstral cycle on the occurrence of PONV should be further investigated.