The Effects of Pre-operative Carbohydrate Fluids on PONV Incidence and Intensity in Orthognathic Surgery Patients
概览
- 阶段
- 不适用
- 干预措施
- Preoperative fasting
- 疾病 / 适应症
- Nausea, Postoperative
- 发起方
- Boston Medical Center
- 入组人数
- 32
- 试验地点
- 1
- 主要终点
- PONV based on the visual analog scale
- 状态
- 尚未招募
- 最后更新
- 4天前
概览
简要总结
This study is a prospective randomized clinical controlled trial testing the effects of pre-operative >50 g pre-operative carbohydrate fluids (apple juice) on a patient's post-operative nausea and vomiting (PONV) incidence and intensity. Optimizing fluid therapy in the peri-operative setting has been proven to improve patient outcomes and reduce complications and length of hospital stay. Based on practice guidelines under the American Society of Anesthesiologists, pre-operative hydration with complex carbohydrate drinks is safe and should be encouraged as it helps with improving metabolism to an anabolic state, decreases insulin resistance, reduces anxiety, and reduces PONV. While pre-operative carbohydrate (CHO) fluids have already been studied and adopted by other surgical specialities (Vascular, General Surgery, Orthopaedics, etc.), this has not yet been studied in oral and maxillofacial surgery, especially at Boston Medical Center (BMC).
During surgery, each participant will undergo our current Enhanced Recovery After Surgery "ERAS" protocol, which includes general anesthesia using inhalational gas, judicious IV fluids, intra-operative steroid and ondansetron (anti-emetic), use of 0.5% bupivacaine local anesthesia per quadrant at surgery end time, use of a throat pack, and orogastric/nasogastric (OG/NG) tube suctioning prior to extubation to minimize ingestion of blood. Pain and anxiety medications prior to and during surgery include 2 mg midazolam, fentanyl per anesthesia, toradol, and dexmedetomidine. Having this protocol will help minimize confounding variables that could affect the primary outcome-- incidence and severity of PONV.
The objectives for this research are:
- To evaluate if pre-operative clear CHO help reduce incidence and intensity of PONV.
- To assess if pre-operative clear carbohydrate fluids affect length of hospital stay
- To determine if pre-operative CHO reduce patient's pre-/post-operative anxiety
- To compare the amount/number of opioids and anti-emetics needed post-operatively between the two groups
- To compare ability for patients to return to PO hydration via the amount of fluid ingestion (mL) vs. if they need IV fluids due to decreased PO intake/inability to tolerate PO fluids
- To evaluate if patient Apfel score is also a strong indicator for incidence/severity of PONV
研究者
入排标准
入选标准
- •Healthy, American Society of Anesthesiologists (ASA) I-II patients undergoing orthognathic surgery (single jaw, double jaw +/- adjunctive procedures including segmental Le Forts/genioplasty/septoplasty/turbinectomy)
- •Operating room (OR) time scheduled prior to 12 pm
排除标准
- •Non-English speaking/poor English comprehension
- •Patient refusal
- •Surgically Assisted Rapid Palatal Expansion (SARPE)
- •Orthognathic surgery patients in addition to adjunctive procedures such as temporomandibular joint (TMJ) replacement, fat grafting, liposuction, or septorhinoplasty
- •General Anesthesia using total IV anesthesia (TIVA)
- •History of gastroesophageal reflux disease (GERD) or patient's with conditions that impair gastrointestinal (GI) motility
- •History of motion sickness or postoperative nausea and vomiting (PONV)
- •Hx of Diabetes Mellitus, endocrine disorders, or allergy to medications of the study
- •Pre-operative scopolamine patch
研究组 & 干预措施
Preoperative fasting
Participants randomized into this group will be fasting/nothing by mouth (NPO) before surgery.
Preoperative carbohydrate drink
Participants randomized into this group will receive a carbohydrate drink before surgery.
干预措施: Carbohydrate drink
结局指标
主要结局
PONV based on the visual analog scale
时间窗: 6 hours and 24 hours after surgery
A visual analog scale from 0-10 (0= No nausea, 10= Worst possible nausea/vomiting) competed by the participant after surgery.
Intensity of post operative nausea and vomiting (PONV)
时间窗: 6 hours and 24 hours after surgery
The post operative nausea and vomiting (PONV) intensity scale will be used to assess this outcome. It has 3 questions about nausea and vomiting and a question about the duration of nausea. Scores of 50 or greater are considered clinically important.
次要结局
- The aount of anti-emetics used for PONV(Discharge from hospital usually1-2 days)
- Post-operative fluid intake by mouth/per os (PO)(Discharge from hospital usually 1-2 days)
- The amount of opioids used for post operative pain(Discharge from hospital usually 1-2 days)
- Frequency of emesis events(Discharge from hospital usually 1-2 days)
- Need for intravenous (IV) fluids(Discharge from hospital usually 1-2 days)
- Length of hospital stay(Discharge from hospital usually1-2 days)