ABSTRACT
To compare the effect of metoclopramide versus midazolam on the incidence of nausea and vomiting after cardiac surgery. Prospective, randomized double blind study. 45 patients aged from 18-60 years old, ASA physical state fl or HI underwent elective cardiac surgery using cardio-pulmonary bypass [CPB] were assigned to one of three groups [15 patients each] according to the antiemetic drug received, group [I], received intravenous saline 0.9% 10 ml/kg [control group], group [fl], received metoclopramide O.lmg/kg IV bolus at time of initiation of CPB, then O.lmg/kg IV after weaning off CPB and every 6 hrs for 24 h postoperative and group [LLJ], received a 1 mg IV bolus of midazolam at time of initiation of CPB, then a continuous infusion of midazolam 0.02 mg/kg/h from the time of successfully weaning off CPB until 24 h after surgery. The following parameters were assessed: visual analogue score [VAS], postoperative nausea and vomiting, dose of rescue antiemetic, Ramsay sedation score, fentanyl consumption during 24 hours and side effects. As regard sedation score, most of the patients were cooperative, oriented and sedated during the 1st postoperative day but sedation was observed more in the midazolam group. The mean nausea score and the incidence of postoperative vomiting were less in group II and group III than the control group and this decrease was significant in the midazolam group when compared to the control group at most of the recorded times. The incidence of postoperative vomiting and dry retching was 53.3%, 20%, 13.3% in the three groups respectively by the end of the 1[st] postoperative day. As regard the need for rescue antiemetic, a significant decrease in the need for rescue antiemetic was observed more in group III compared to the other two groups. As regard complications and side effects, no patient in the study groups had any drug related complications or developed any electrocardiograph