Ondansetron vs. metoclopramide for the prevention of nausea and vomiting after gynecologic surgery.

BACKGROUND: Postoperative nausea and vomiting (PONV) remains a very troublesome concomitant phenomenon after general anesthesia. The present study was designed to compare the efficacy and safety of ondansetron with metoclopramide for prophylaxis of PONV in patients undergoing major gynecological surgery. MATERIAL AND METHOD: A prospective, randomized, double-blind, 382 female patients received either ondansetron 4 mg or metoclopramide 10 mg intravenous administration immediately before the induction of anesthesia. A standard general anesthetic technique was employed throughout. Nausea, vomiting, and safety assessments were performed continuously during the 24 h postoperative period. RESULTS: Of the 380 patients evaluated, significantly fewer ondansetron 4 mg treated patients (89/189; 47%) experienced postoperative nausea and/or vomiting compared with metoclopramide treated patients (115/ 191; 60%) during the study period (p = 0.007, 95% CI: 1.07, 1.66). Postoperative adverse events were not significantly different between the groups. CONCLUSION: Prophylactic use of ondansetron is more effective than metoclopramide for preventing PONV in patients undergoing major gynecological surgery.

Comparison on pain on injection of a small particle size-lipid emulsion of propofol and standard propofol with or without lidocaine.

Pain on injection, reported in 28-90% of patients, is one of the most described side effects of the intravenous application of propofol. Many different approaches have been used in attempts to minimize propofol induced pain, with varied results. Using a randomized, double-blind protocol design, the author-section pain following the administration of two different particle size formulations of propofol with or without lidocaine in 388 nonpremedicated ASA I-II adult patients scheduled for elective surgery under general anesthesia. Patients were allocated randomly to receive either a small particle size lipid emulsion of propofol (Anepol: average particle size 140.5 nm), or standard propofol (Propofol: average particle size 193.3 nm), by dividing into 4 groups. Group 1 received 2 ml NaCl 0.9% and Propofol, group 11 received 2 ml lidocaine 2% and Propofol, group III received 2 ml NaCl 0.9% and Anepol and group IV received 2 ml lidocaine 2% and Anepol into a dorsal vein of the hand. Pain during propofol injection was evaluated over 5-10 seconds, until loss of conscious, using a four point scale. Sixty-seven patients (69.1%) complained of pain in group 1, as compared with 50%, 41.2% and 39.2% in group II, III and IV (p < 0.05). The reported severity of injection pain was not significantly different between the groups. The authors conclude that small particle size propofol causes less pain on injection than standard propofol.

Comparison of postanesthetic complaints after general and spinal anesthesia in patients undergoing lower limb surgery.

BACKGROUND: The choice of anesthesia is one of the most important decisions made by anesthesiologists after preoperative visits with orthopedic patients. No published study has yet quantified the incidence of postanesthetic complaints for either technique. The present study was designed to compare the incidences of postanesthetic complaints after the application of the standardized techniques of spinal anesthesia, using a 27 - gauge needle, and two forms of general anesthesia in patients undergoing lower limb surgery. MATERIAL AND METHOD: In a prospective, randomized, observer blind trial, 260 orthopedic patients who underwent lower limb surgery were randomized into 3 groups; 1) spinal anesthesia (SA), 2) general anesthesia via facemask (GA-M), 3) general anesthesia via endotracheal intubation (GA-T). On postoperative days 1 and 3, patients were interviewed specifically about postanesthetic complaints. RESULTS: The present study indicated that the incidence of backache was significantly higher in SA (p = 0.01), while nausea/vomiting (p = 0.00) and headache (p = 0.02) were more frequent in GA-M and GA-T on the first postoperative day. In the 3-day period of observation in the ward, the incidence of postoperative complaints did not significantly differ among the three groups. CONCLUSION: Spinal anesthesia using a 27-gauge Quincke needle is associated with a lower incidence of postanesthetic complaints compared with general anesthesia. This technique may be recommended for patients undergoing lower limb surgery.