Copyright © 2019 International Anesthesia Research Society. Unauthorized reproduction of this article is prohibited. October 2019 • Volume 129 • Number 4 www.anesthesia-analgesia.org 943 DOI: 10.1213/ANE.0000000000004019 A lthough advances have been made in postopera- tive nausea and vomiting prophylaxis, a signif- cant proportion of patients, particularly those with established patient and surgical risk factors, suffer from postoperative nausea and vomiting. 1–3 Interval published guidelines provide an algorithm for identifcation of rel- evant postoperative nausea and vomiting risk factors as well as selection of appropriate prophylactic and treatment antiemetics. 3 Among the described therapies is the con- certed use of perioperative crystalloid to ensure adequate resuscitation, which has been shown to be associated with a reduction in both the incidence and severity of postopera- tive nausea and vomiting. 4 More recently, researchers have introduced an additional fuid-related measure in the form of perioperative dextrose infusions. While some studies have reported a signifcant reduction in postoperative nau- sea and vomiting incidence and antiemetic requirements through the use of a perioperative dextrose infusion, 5–7 results are more conficted among other trials. 8,9 Given the controversy and the potential implications for periopera- tive postoperative nausea and vomiting management, our group conducted a meta-analysis of published randomized BACKGROUND: Perioperative IV dextrose infusions have been investigated for their potential to reduce the risk of postoperative nausea and vomiting. In this meta-analysis, we investigated the use of an intraoperative or postoperative infusion of dextrose for the prevention of postopera- tive nausea and vomiting. METHODS: Our group searched PubMed, Embase, Cochrane library, and Google Scholar for rel- evant randomized controlled trials examining the use of perioperative IV dextrose for prevention of postoperative nausea and vomiting. The primary outcome was the incidence of postoperative nausea and vomiting (both in the postanesthesia care unit and within the frst 24 h of surgery). Secondary outcomes included postoperative antiemetic administration and serum glucose level. RESULTS: Our search yielded a total of 10 randomized controlled trials (n = 987 patients) com- paring the use of a perioperative dextrose infusion (n = 465) to control (n = 522). Perioperative dextrose infusion was not associated with a signifcant reduction in postoperative nausea and vomiting in the postanesthesia care unit (risk ratio = 0.91, 95% CI, 0.73–1.15; P = .44) or within the frst 24 h (risk ratio = 0.76, 95% CI, 0.55–1.04; P = .09) of surgery. Although the use of dextrose was associated with a signifcant reduction in antiemetic administration within the frst 24 h (risk ratio = 0.55, 95% CI, 0.45–0.69; P < .001), it also increased postoperative plasma glucose levels compared to controls. CONCLUSIONS: The use of perioperative dextrose did not result in a statistically signifcant association with postoperative nausea and vomiting. When utilized, plasma glucose monitoring is recommended to assess for postoperative hyperglycemia. Further prospective trials are necessary to examine the potential impact of timing of administration of a dextrose infusion on incidence of postoperative nau- sea and vomiting and rescue antiemetic requirements. (Anesth Analg 2019;129:943–50) Perioperative Dextrose Infusion and Postoperative Nausea and Vomiting: A Meta-analysis of Randomized Trials Andres Zorrilla-Vaca, BS,* Diana Marmolejo-Posso, BS,* Alexander Stone, MD,† Jinlei Li, MD,‡ and Michael C. Grant, MD§ From the *Faculty of Health, Universidad del Valle School of Medicine, Cali, Colombia; †Department of Anesthesiology, Brigham and Women’s Hospital, Boston, Massachusetts; ‡Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut; and §Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University, Baltimore, Maryland. Accepted for publication December 11, 2018. Funding: None. The authors declare no conficts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (www.anesthesia-analgesia.org). Reprints will not be available from the authors. Address correspondence to Michael C. Grant, MD, Department of Anesthesi- ology and Critical Care Medicine, The Johns Hopkins University, Baltimore, MD. Address e-mail to mgrant17@jhmi.edu. Copyright © 2019 International Anesthesia Research Society E META-ANALYSIS KEY POINTS • Question: Does perioperative dextrose infusion reduce the incidence of postoperative nausea and vomiting? • Findings: The use of a perioperative dextrose infusion was not associated with a significant reduction in postoperative nausea and vomiting in the postanesthesia care unit or within 24 h of surgery. • Meaning: Perioperative dextrose infusions are not recommended for routine prevention of postoperative nausea and vomiting. Further studies are necessary to verify the impact of peri- operative dextrose infusions on severity of postoperative nausea and vomiting and antiemetic administration.