Impact of 10 mL/kg versus 20 mL/kg Ringer’s Lactate Preloading on Postoperative Nausea and Vomiting Following General Anesthesia

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Background and Aims: Fasting patients develop gut mucosal ischemia, which increases the risk of postoperative nausea and vomiting (PONV). We assessed the effect of two preloading doses of Ringer’s lactate (RL) on PONV, intraoperative hemodynamics, and duration of intensive care unit (ICU) stay. Materials and Methods: It was a prospective, randomized, single-blind study conducted at a tertiary care center. One hundred and twenty-four patients were allotted into two equal groups. Before induction of general anesthesia, Group A patients received RL at 20 mL/kg and Group B at 10 mL/kg, and the infusion was continued intraoperatively at 2 mL/kg/h in both groups. All patients received standardized anesthesia and were extubated on the table after receiving ondansetron 0.1 mg/kg intravenously. Independent samples t test and chi-squared test were used for statistical analysis. Results: Significantly higher number of patients (90.32%) in Group A had no vomiting, dry retching, or nausea compared with 72.58% of patients in Group B. Grade 1, 2, and 3 symptoms were significantly higher in Group B. Risk factors based on the Apfel score were comparable between the two groups. The need for ondansetron rescue therapy was significantly lower in Group A compared to Group B (9.68% vs. 27.42%). However, the requirement of metoclopramide was comparable. Hemodynamic parameters were comparable intraoperatively. Total volume of RL used was significantly higher in Group A ( P < 0.0001). Duration of surgery and ICU stay, dose of propofol used, and fentanyl consumption were comparable between the two groups. Conclusion: Intravenous preloading using 20 mL/kg body weight of RL before induction of general anesthesia significantly reduced the incidence and severity of PONV compared with 10 mL/kg preloading.