Newly Published
Perioperative Medicine  |   April 2020
Muscular Tissue Oxygen Saturation and Posthysterectomy Nausea and Vomiting: The iMODIPONV Randomized Controlled Trial
Author Notes
  • From the Department of Anesthesiology, Peking University Third Hospital, Beijing, China (G.L., X.G.); the Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China (D.-D.T., Y.-Q.A., J.-J.Y.); the Department of Anesthesiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, China (X.W., M.Z.); the Department of Anesthesiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China (X.F., Y.L.); the Department of Anesthesiology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China (W.Z., M.X., X.C.); the Department of Anesthesiology, Peking University First Hospital, Beijing, China (J.B., D.-X.W., D.-L.M.); the Department of Biostatistics, Yale University School of Public Health, Yale Center for Analytical Sciences, New Haven, Connecticut (F.D.); and the Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut (X.Z., D.Y., L.M.).
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • Submitted for publication October 22, 2019. Accepted for publication March 10, 2020.
    Submitted for publication October 22, 2019. Accepted for publication March 10, 2020.×
  • Correspondence: Address correspondence to Dr. Meng: Yale University School of Medicine, 333 Cedar Street, TMP 3, P.O. Box 208051, New Haven, Connecticut 06520. lingzhong.meng@yale.edu. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Respiratory System
Perioperative Medicine   |   April 2020
Muscular Tissue Oxygen Saturation and Posthysterectomy Nausea and Vomiting: The iMODIPONV Randomized Controlled Trial
Anesthesiology Newly Published on April 20, 2020. doi:https://doi.org/10.1097/ALN.0000000000003305
Anesthesiology Newly Published on April 20, 2020. doi:https://doi.org/10.1097/ALN.0000000000003305
Abstract

Background: Suboptimal tissue perfusion and oxygenation during surgery may be responsible for postoperative nausea and vomiting in some patients. This trial tested the hypothesis that muscular tissue oxygen saturation–guided intraoperative care reduces postoperative nausea and vomiting.

Methods: This multicenter, pragmatic, patient- and assessor-blinded randomized controlled (1:1 ratio) trial was conducted from September 2018 to June 2019 at six teaching hospitals in four different cities in China. Nonsmoking women, 18 to 65 yr old, and having elective laparoscopic surgery involving hysterectomy (n = 800) were randomly assigned to receive either intraoperative muscular tissue oxygen saturation–guided care or usual care. The goal was to maintain muscular tissue oxygen saturation, measured at flank and on forearm, greater than baseline or 70%, whichever was higher. The primary outcome was 24-h postoperative nausea and vomiting. Secondary outcomes included nausea severity, quality of recovery, and 30-day morbidity and mortality.

Results: Of the 800 randomized patients (median age, 50 yr [range, 27 to 65]), 799 were assessed for the primary outcome. The below-goal muscular tissue oxygen saturation area under the curve was significantly smaller in patients receiving muscular tissue oxygen saturation–guided care (n = 400) than in those receiving usual care (n = 399; flank, 50 vs. 140% · min, P < 0.001; forearm, 53 vs. 245% · min, P < 0.001). The incidences of 24-h postoperative nausea and vomiting were 32% (127 of 400) in the muscular tissue oxygen saturation–guided care group and 36% (142 of 399) in the usual care group, which were not significantly different (risk ratio, 0.89; 95% CI, 0.73 to 1.08; P = 0.251). There were no significant between-group differences for secondary outcomes. No harm was observed throughout the study.

Conclusions: In a relatively young and healthy female patient population, personalized, goal-directed, muscular tissue oxygen saturation–guided intraoperative care is effective in treating decreased muscular tissue oxygen saturation but does not reduce the incidence of 24-h posthysterectomy nausea and vomiting.

Editor’s Perspective:

What We Already Know about This Topic:

  • Suboptimal tissue perfusion and oxygenation may provoke nausea and vomiting

What This Article Tells Us That Is New:

  • Eight hundred relatively young women having laparoscopic hysterectomies were randomized to routine care or to muscle tissue oxygenation maintained at greater than baseline or 70%, whichever was higher

  • Guided management improved tissue oxygenation but did not reduce nausea and vomiting