{"title":"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。","authors":"Thrivikrama P Tantry, Shraddha Nuliyalu, Madhura Rao, Neha Aras, Harish Karanth, Madhusudan Upadya, Dinesh Kadam","doi":"10.23736/S0375-9393.25.18941-4","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>The relationship between intraoperative end-tidal carbon dioxide (EtCO<inf>2</inf>) levels and postoperative nausea and vomiting (PONV) has gained research interest. This meta-analysis aims to elucidate the relationship between intraoperative EtCO<inf>2</inf> levels and PONV incidence through a systematic review and synthesis of available evidence, thereby addressing the existing knowledge gap in the perioperative care.</p><p><strong>Evidence acquisition: </strong>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 EtCO<inf>2</inf> 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.</p><p><strong>Evidence synthesis: </strong>In the first comparison (seven trials, N.=475), the RR for PONV incidence with higher EtCO<inf>2</inf> (≥35 mmHg) was 0.80 (95%CI, 0.35-1.84, P=0.60, I<sup>2</sup>=72%). In the second, (six trials, N.=1639), the RR for PONV with higher EtCO<inf>2</inf> (≥40 mmHg) was 0.82 (95% CI, 0.67-1.00, P=0.051, I<sup>2</sup>=0%). For other outcomes, nausea scores with high EtCO<inf>2</inf> (≥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 EtCO<inf>2</inf> values (for EtCO<inf>2</inf>, meta-regression P=0.278).</p><p><strong>Conclusions: </strong>The analysis does not provide strong evidence that EtCO<inf>2</inf> 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.</p>","PeriodicalId":18522,"journal":{"name":"Minerva anestesiologica","volume":"91 9","pages":"817-827"},"PeriodicalIF":2.8000,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Association between intraoperative end tidal carbon dioxide levels and postoperative nausea and vomiting: a systematic review and meta-analysis.\",\"authors\":\"Thrivikrama P Tantry, Shraddha Nuliyalu, Madhura Rao, Neha Aras, Harish Karanth, Madhusudan Upadya, Dinesh Kadam\",\"doi\":\"10.23736/S0375-9393.25.18941-4\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>The relationship between intraoperative end-tidal carbon dioxide (EtCO<inf>2</inf>) levels and postoperative nausea and vomiting (PONV) has gained research interest. This meta-analysis aims to elucidate the relationship between intraoperative EtCO<inf>2</inf> levels and PONV incidence through a systematic review and synthesis of available evidence, thereby addressing the existing knowledge gap in the perioperative care.</p><p><strong>Evidence acquisition: </strong>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 EtCO<inf>2</inf> 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.</p><p><strong>Evidence synthesis: </strong>In the first comparison (seven trials, N.=475), the RR for PONV incidence with higher EtCO<inf>2</inf> (≥35 mmHg) was 0.80 (95%CI, 0.35-1.84, P=0.60, I<sup>2</sup>=72%). In the second, (six trials, N.=1639), the RR for PONV with higher EtCO<inf>2</inf> (≥40 mmHg) was 0.82 (95% CI, 0.67-1.00, P=0.051, I<sup>2</sup>=0%). For other outcomes, nausea scores with high EtCO<inf>2</inf> (≥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 EtCO<inf>2</inf> values (for EtCO<inf>2</inf>, meta-regression P=0.278).</p><p><strong>Conclusions: </strong>The analysis does not provide strong evidence that EtCO<inf>2</inf> 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.</p>\",\"PeriodicalId\":18522,\"journal\":{\"name\":\"Minerva anestesiologica\",\"volume\":\"91 9\",\"pages\":\"817-827\"},\"PeriodicalIF\":2.8000,\"publicationDate\":\"2025-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Minerva anestesiologica\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.23736/S0375-9393.25.18941-4\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ANESTHESIOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Minerva anestesiologica","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.23736/S0375-9393.25.18941-4","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
Association between intraoperative end tidal carbon dioxide levels and postoperative nausea and vomiting: a systematic review and meta-analysis.
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.
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.
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