Combination therapy in the prevention of PONV after strabismus surgery in children: granisetron, ondansetron, midazolam with dexamethasone

Pediatric strabismus surgery is commonly associated with higher incidence of postoperative nausea and vomiting [PONV]. Mixture of different classes of antiemetics have been used successfully to decrease the incidence of PONV but there was no agreement on the optimal combination. The aim of this study was to investigate the effect of granisetron, ondansetron, midazolam combination with dexamethasone in the prevention of PONV following strabismus repair in pediatric population. Healthy 100 children ASA class I and II aged 4-12 years, scheduled for elective strabismus surgery, were enrolled in this study. No premedications were given anesthesia was induced by inhalational techniques using sevoflurane, nitrous oxide and oxygen mixture. After induction, fentanyl and atracurium were given and an endotracheal tube was inserted. Patients were randomly divided into four groups which received intravenously either: Placebo, or a combination of granisetron 10 micro g/kg[-1], ondansetron 50 micro g/kg[-1], midazolam 50 micro g/kg[-1], plus dexamethasone 0.5 mg/kg [-1] after induction of anesthesia and before start of surgery. All episodes of PONV during the first 24 hours anesthesia were recorded. The incidence of postoperative nausea was 48%, 8%, 12% and 0% while the incidence of vomiting was 52%, 12%, 4% and 0% in placebo, granisetron, ondansetron, midazolam and dexamethasone combination groups respectively. No difference was detected between combination groups [P value >0.05]. Prophylactic administration of either of either granisetron, ondansetron, midazolam combined with dexamethasone markedly decreases the incidence of PONV following strabismus surgery in pediatrics. All combinations are equally effective

Study of cytokines and postoperative outcome after laparoscopic and open cholecystectomy

To investigate stress response and postoperative outcome in laparoscopic and open cholecystectomy. In addition, to compare between two anesthetic techniques for laparoscopic cholecystectomy as regards serum cytokines changes and postoperative outcome. Thirty patients scheduled for elective cholecystectomy for gall stone disease were classified into 3 equal groups. Group I: underwent open cholecystectomy under halothane anesthesia; Group II : underwent laparoscopic cholecystectomy under halothane anesthesia; Group III : underwent laparoscopic cholecystectomy under isoflurane anesthesia. All patients were subjected to the following : [1] Measurements of IL-6, IL-1 before anesthesia, I hour and 24 hours postoperatively; [2] Recordings the time to eye opening and orientation to persons and place; [3] Evaluation of postoperative pain at 1, 6, 12, 24 h and 48 h postoperatively; [4] Frequency of nausea and vomiting; [5] Length of the hospital stay, IL-6 and IL-I increased significantly in the-three groups at 1 hour postoperatively, then decreased significantly at 24 hours postoperatively. The differences between group I and group II or III was significant, but there was no significant difference between group II and group III. Laparoscopic groups [II and III] were associated with less postoperative pain and narcotic requirements compared with open group [I] while no significant difference between laparoscopic group [II and III]. Nausea and vomiting were encountered more frequent in laparoscopic groups than in open group, but the difference was not significant. Hospital stay was significantly short in laparoscopic group than in open group. Time to eye opening and time to orientation to place and person were significantly short in isoflurane laparoscopic cholecystectomy group than halothane laparoscopic cholecystectomy group. [1] Laparoscopic cholecystectomy is associated with less tissue injury and less stress response as indicated by lower serum levels of IL-6 and IL-1 compared to open cholecystectomy; [2] Laparoscopic cholecystectomy is associated with better postoperative outcome as indicated by less postoperative narcotic requirements and short hospital stay; [3] Apart from early eye opening and early orientation associated with isoflurane anesthesia, it exerts minor influence on postoperative outcome compared to fluthane anesthesia for laparoscopic cholecystectomy