Efficacy and Risks of Dextrose Infusion to Prevent Postoperative Nausea: a Narrative Review

Area of Science:

• Anesthesiology and Perioperative Medicine
• Gastroenterology
• Pharmacology

Background:

• Postoperative nausea and vomiting (PONV) is a frequent surgical complication impacting recovery and increasing costs.
• Traditional antiemetics like 5-HT3 antagonists carry risks, including potential cardiac arrhythmias, limiting their use in some patients.
• Non-pharmacologic strategies are sought to mitigate PONV, especially for patients with contraindications to standard treatments.

Purpose of the Study:

• To evaluate the efficacy of perioperative intravenous dextrose infusion as a non-pharmacologic strategy for PONV prevention.
• To assess the impact of dextrose on nausea, vomiting, and the need for rescue antiemetics.
• To identify potential benefits and risks associated with dextrose infusion in the perioperative setting.

Main Methods:

• Review of clinical evidence, including meta-analyses and randomized controlled trials.
• Analysis of dextrose's physiological effects on glucose metabolism, insulin secretion, and autonomic stress responses.
• Assessment of dextrose's impact on PONV symptoms and antiemetic requirements.

Main Results:

• Intravenous dextrose may decrease nausea and reduce the need for rescue antiemetics in PONV patients.
• The effect of dextrose on vomiting episodes is inconsistent and may depend on surgical type and patient comorbidities.
• Dextrose is inexpensive and accessible but requires monitoring for hyperglycemia and electrolyte imbalances.

Conclusions:

• Perioperative intravenous dextrose is a physiologically sound and cost-effective adjunct for PONV prophylaxis.
• Dextrose shows potential benefits in select surgical populations, particularly for nausea reduction.
• Further research is needed to optimize patient selection, infusion protocols, and monitoring for safe and effective implementation.