Discussion
obese, POV, strabismus, neuromuscular paralysis, PONV
OBESE, STRABISMUS, PATHOPHYSIOLOGY
In this prospective, double-blinded, randomized controlled trial, our findings show that 48% of the patients experienced PONV within the first 48 h postoperatively, with 51% in the Control group and 46% in the PHC group. Moreover, the expected results were not obtained. During the early postoperative period, penehyclidine failed to induce a significant difference with respect to the incidence and severity of PONV, PON, and POV; need for rescue antiemetic therapy; or volume of water intake. However, a single intravenous dose of penehyclidine (0.5 mg) was associated with a slightly prolonged time to first flatus.The consensus guidelines for the management of PONV include bariatric surgery as having an increased risk of PONV [To date, penehyclidine, as a preanesthetic medication, is used mainly to reduce respiratory secretions and inhibit the vagus nerve reflex without increasing the heart rate. Nevertheless, there is insufficient high-quality evidence to confirm the protective effect of penehyclidine against PONV. In a recent prospective study of 228 pediatric patients undergoing strabismus surgery, patients receiving penehyclidine (0.01 mg/kg, maximal dose 0.5 mg, intravenously) after anesthesia induction had a significantly lower incidence and severity of PONV within 48 h postoperatively [Postoperative water intake volume and time to first flatus are two important indices for evaluating recovery of gastrointestinal function after surgery. Early oral hydration after laparoscopic cholecystectomy has been associated with a lower incidence of PONV in the ward [A few issues concerning our study need to be clarified. Sugammadex and neostigmine are both commonly used to antagonize NMBDs-induced neuromuscular paralysis in the clinical setting. Considering its beneficial effects on providing fast recovery of neuromuscular function, we tend to recommend sugammadex for the patients with BMI ≥ 35 kg/mThis study has some limitations. First, we just enrolled patients undergoing elective LBS, who are aged 18–60 years and ASA physical status I–III. Futhermore, this was a single-center study with relatively small sample size, which limits the generalizability of the results. The results of this trial should be considered with caution. In the future, large multi-center randomized controlled prospective studies should be conducted to comprehensively observe the safety and efficacy of penehyclidine in patients undergoing LBS. Second, further in-depth studies are needed to determine the appropriate dosage of penehyclidine to prevent PONV in obese patients, which needs to bring in the assessment of the volume of distribution. An improved understanding of the pathophysiology of PONV in patients undergoing LBS is needed to guide future studies.