Postoperative nausea and vomiting in diagnostic gynaecological laparoscopic procedures: comparison of the efficacy of the combination of dexamethasone and metoclopramide with that of dexamethasone and ondansetron.

BACKGROUND AND OBJECTIVE: This study was conducted in a tertiary hospital with the aim of comparing the efficacy of a combination of dexamethasone and metoclopramide with dexamethasone and ondansetron for the prophylaxis of postoperative nausea and vomiting [PONV] after diagnostic gynaecological laparoscopic procedures. SUBJECTS AND METHODS: In this prospective, randomised, double-blind study, 120 women received either saline I.V. [Group I, n=40]; a combination of dexamethasone [8 mg] with metoclopramide [10 mg] [Group II, n=40]; or a combination of dexamethasone [8 mg] with ondansetron [4 mg] [Group III, n=40] prior to induction of general anaesthesia. PONV was evaluated at regular intervals. The results were analysed using one-way ANOVA, post-hoc, Chi-square, Kruskal-Wallace tests and Z test for proportions where appropriate through a SPSS V.9 package. RESULTS: The 3 groups were well matched for demographic characteristics. The incidence of nausea and emesis was significantly lower in Group III [[17.5%, P <0.02] and [10%, P <0.01] respectively]. Nausea scores were also lower in Group III [P <0.02]. Rescue anti-emetic requirements were higher in Group I [P <0.05] as compared to Groups II and III. CONCLUSIONS: A combination of dexamethasone and ondansetron was more efficacious as compared to that of metoclopramide and dexamethasone. The combination of metoclopramide and dexamethasone seems to offer no additional benefit as compared to saline placebo.

Percutaneous tracheostomy by guidewire dilating forceps technique: review of 98 patients.

BACKGROUND: Percutaneous tracheostomy to a large extent has replaced conventional surgical tracheostomy by virtue of its low incidence of complications and the rapidity with which the procedure can be performed at the bedside avoiding transport of critically ill patients to the operating rooms. Since it is a blind approach, bronchoscopic guidance has been suggested which might not always be possible due to logistic reasons. METHODS: A retrospective study of 98 patients who had guide wire dilating forceps technique of percutaneous tracheostomy without the aid of a bronchoscope was undertaken. By ensuring the free mobility of the guide wire at each step of the procedure, a safe placement of the tracheostomy tube was achieved. RESULTS: The mean operating time was 3.05 mins [S.D:2.20]. Two patients had peristomal bleeding as an early complication. 34 patients could be decannulated with good primary approximation of the stomal tissues [mean: 3.92days, S.D: 1.46]. There were no deaths or life threatening complications attributable to this technique. CONCLUSIONS: In the absence of bronchoscopic guidance, adopting the simple but effective precaution of free movement of guide wire at each step of the procedure, a safe tracheostomy tube placement is possible.

Adenosine as an adjunct to inducing rapid asystole during cardioplegic arrest.

A study was undertaken in 68 patients to assess the beneficial effect of adenosine as an adjunct to K(+)-enriched cardioplegia to induce rapid asystole. In the study group (n = 22), adenosine was given in the dose of 3 mg bolus into the aortic root immediately after aortic cross clamp along with K(+)-enriched cardioplegia. In the control group (n = 46) K(+)-enriched cardioplegia solution was used without adenosine. Important parameters monitored were: time to asystole in seconds and recovery of normal sinus rhythm following release of aortic cross clamp. In addition, standard haemodynamic parameters were measured. The results showed a marked reduction in the time to achieve asystole in the study group (3.53 +/- 1.18 seconds) as compared to the control group (18.19 +/- 11.80 seconds) (p < 0.001). Restoration of sinus rhythm was achieved in the study group at 43.53 +/- 33.60 seconds while in the control group it was achieved at 161.90 +/- 11.36 seconds (p < 0.001). The haemodynamic parameters measured 10 minutes after the termination of cardiopulmonary bypass were not different in the two groups. When measured one hour after the termination of cardiopulmonary bypass, haemodynamic parameters in the study group revealed a statistically significant improvement in inotropicity. No side effects or complications were encountered in the study group. We conclude that adenosine given as an adjunct to K(+)-enriched cardioplegia helps to achieve rapid asystole and faster recovery of sinus rhythm with no adverse effects and may aid in better myocardial preservation.

Efficacy of minimal dose aprotinin in open heart procedures.

In a randomized double blind study, 30 patients posted for CABG surgery were assigned to 3 groups of 10 each. Group A received 140 mg (1,000,000 KIU) of aprotinin after induction of anaesthesia but before sternotomy, an equal amount in the pump prime and a maintenance dose of 70 mg/hr throughout cardiopulmonary bypass (standard dose). Group B received placebo after induction of anaesthesia, 70 mg (500,000 KIU) aprotinin in the pump prime with a placebo as a maintenance dose (minimal dose). Group C received a placebo after induction of anaesthesia, in the prime and as a maintenance dose (control group). The mean chest closure times were insignificantly lower in the aprotinin groups; 35.83 +/- 13.93 mins in group A and 37.5 +/- 10 mins in group B as against 57.25 +/- 26.54 mins in group C. Post-operative haemoglobin loss was significantly lower (P<0.01) in aprotinin groups, 5.42 +/- 1.6 gm in group A and 6.28 +/- 2.49 gms in group B, as against 39.77 +/- 27.51 gm in group C. Whole blood transfusion requirement was also significantly reduced from 4.12 +/- 1.79 units in the control group to 2.5 +/- 0.75 units in group A (p < 0.05) and 2 +/- 1.3 units (p<0.01) in group B. We conclude that a minimal dose of aprotinin 70 mg (500,000 KIU) is effective in reducing postoperative blood loss, blood transfusion requirement and is economical.