Association between intraoperative end tidal carbon dioxide levels and postoperative nausea and vomiting: a systematic review and meta-analysis.

IF 2.8 3区医学 Q1 ANESTHESIOLOGY

Minerva anestesiologica Pub Date : 2025-09-01 DOI:10.23736/S0375-9393.25.18941-4

Thrivikrama P Tantry, Shraddha Nuliyalu, Madhura Rao, Neha Aras, Harish Karanth, Madhusudan Upadya, Dinesh Kadam

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引用次数: 0

Abstract

Introduction: The relationship between intraoperative end-tidal carbon dioxide (EtCO2) levels and postoperative nausea and vomiting (PONV) has gained research interest. This meta-analysis aims to elucidate the relationship between intraoperative EtCO2 levels and PONV incidence through a systematic review and synthesis of available evidence, thereby addressing the existing knowledge gap in the perioperative care.

Evidence acquisition: We conducted a meta-analysis of randomized controlled trials (RCTs) to investigate this association, examining PONV incidence, nausea scores, and rescue antiemetic use. Our analysis included 10 RCTs (N.=1860), comparing EtCO2 levels of <35 vs. ≥35 mmHg and <40 vs. ≥40 mmHg. In the random-effects statistical models, pooled risk/odds ratios (RR/ORs) or mean differences (MDs), 95%CIs, and P values were estimated for endpoints.

Evidence synthesis: In the first comparison (seven trials, N.=475), the RR for PONV incidence with higher EtCO2 (≥35 mmHg) was 0.80 (95%CI, 0.35-1.84, P=0.60, I²=72%). In the second, (six trials, N.=1639), the RR for PONV with higher EtCO2 (≥40 mmHg) was 0.82 (95% CI, 0.67-1.00, P=0.051, I²=0%). For other outcomes, nausea scores with high EtCO2 (≥40 mmHg) showed a MD of 0.94 (95%CI: -1.55-3.43, P=0.46, N.=456). Rescue antiemetic use showed no significant reduction with hypercapnia (OR, 0.48, 95%CI: 0.21-1.06, P=0.07, N.=548). Meta-regression analysis revealed no significant associations between PONV incidence and predictors including age, BMI, laparoscopic surgery, female gender, surgery duration, and intraoperative EtCO2 values (for EtCO2, meta-regression P=0.278).

Conclusions: The analysis does not provide strong evidence that EtCO2 levels are a key factor in influencing PONV incidence, even when the available covariates or the factors examined. Further large-scale, well-designed studies are needed to clarify this relationship and explore potential interactions with other PONV risk factors.

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术中末潮二氧化碳水平与术后恶心和呕吐之间的关系：一项系统回顾和荟萃分析。

导论：术中潮末二氧化碳（EtCO2）水平与术后恶心呕吐（PONV）的关系引起了人们的研究兴趣。本荟萃分析旨在通过系统回顾和综合现有证据，阐明术中EtCO2水平与PONV发生率之间的关系，从而解决围手术期护理的现有知识空白。证据获取：我们进行了一项随机对照试验（rct）的荟萃分析，以调查这种关联，检查PONV发生率、恶心评分和抢救止吐药的使用。我们的分析纳入了10个rct (n =1860)，比较了证据合成的EtCO2水平：在第一个比较中（7个试验，n =475），较高EtCO2（≥35 mmHg）的PONV发生率的RR为0.80 （95%CI, 0.35-1.84， P=0.60, I2=72%）。在第二项试验中（6项试验，n =1639），高EtCO2(≥40 mmHg) PONV的RR为0.82 （95% CI, 0.67-1.00， P=0.051, I2=0%）。对于其他结果，高EtCO2（≥40 mmHg）的恶心评分显示MD为0.94 （95%CI: -1.55-3.43， P=0.46, n =456）。急救止吐剂的使用没有显著减少高碳酸血症（OR, 0.48, 95%CI: 0.21-1.06， P=0.07, n =548）。meta回归分析显示，PONV发病率与年龄、BMI、腹腔镜手术、女性性别、手术时间和术中EtCO2值等预测因子之间无显著相关性（EtCO2， meta回归P=0.278）。结论：即使检查了可用的协变量或因素，该分析也没有提供强有力的证据表明EtCO2水平是影响PONV发病率的关键因素。需要进一步的大规模、精心设计的研究来澄清这种关系，并探索与其他PONV危险因素的潜在相互作用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Minerva anestesiologica 医学-麻醉学

CiteScore

4.50

自引率

21.90%

发文量

367

审稿时长

4-8 weeks

期刊介绍： Minerva Anestesiologica is the journal of the Italian National Society of Anaesthesia, Analgesia, Resuscitation, and Intensive Care. Minerva Anestesiologica publishes scientific papers on Anesthesiology, Intensive care, Analgesia, Perioperative Medicine and related fields. Manuscripts are expected to comply with the instructions to authors which conform to the Uniform Requirements for Manuscripts Submitted to Biomedical Editors by the International Committee of Medical Journal Editors.