Preoperative fluid bolus and reduction of postoperative nausea and vomiting in patients undergoing laparoscopic gynecologic surgery.

We conducted a randomized clinical trial of patients undergoing laparoscopic gynecologic surgery to determine the effect of a calculated preoperative fluid bolus on postoperative nausea and vomiting (PONV). For the study, 46 women were randomly assigned to an experimental group, group 1, or a control group, group 2. Group 1 received up to 1,000 mL of replacement fluid preoperatively, using the 4-2-1 formula. Group 2 received the anesthesia provider's routine replacement fluids. Neither group received antiemetics preoperatively or intraoperatively. All patients were assessed for PONV by nurses blinded to patient group assignment. Group 1 patients experienced significantly lower occurrences of PONV than did group 2 patients (P = .046). The preoperative fluid bolus seemed to be a significant factor in preventing PONV in group 1. Demographic and other factors reported to cause PONV, such as the length of surgery and major manipulation of the bowels, were similar in both groups. There was no significant difference between groups in reception of postoperative opioid, a known cause of PONV. Drops in blood pressure were thought to affect PONV, but group 1 patients had larger decreases in blood pressure than did group 2 patients.