[Effect of metoclopramide and ondansetrone plus dexamethason on postoperative nausea and vomiting in cholecystectomy laparoscopic surgery]

Nausea and vomiting are common complications after surgery which creates spasm, hypoxia and pulmonary aspiration. This study was done to determine the effect of ondansetrone, metoclopramide associated with dexamethasone on postoperative nausea and vomiting in cholecystectomy surgery using Laparoscopic method. In this double blind clinical trial study, 100 patients with ASA class I and II undergoing laparoscopic cholecystectomy divided randomly into two groups. The patients in the first group were received metoclopramide [10mg/kg/bw] with dexamethasone [8mg/kg/bw] and the second group were received ondansetron [4mg/kg/bw] with dexamethasone [8mg/kg/bw] intravenously 5 min before the final stage of surgery. Premedication and induction of anesthesia in patients were equal 5 minutes to 4 hours after surgery, postoperative nausea and vomiting were recorded for each patient. The rate of nausea in the first and the second groups were recorded 38% and 28%, respectively. The rate of vomiting in the first and the second groups were recorded 30% and 16%, respectively. These values were not significant. Ondansetron with dexamethasone non significantly reduced postoperative nausea and vomiting after laparoscopic cholecystectomy in comparison with metoclopramide with dexamethasone

[ case of post-intubation tracheal stenosis and tracheoesophageal fistula]

The presence of tracheal or tracheostomy tubes for long term in trachea, especially with nasogastric tube synchoronously, could be complicated by tracheal stenosis, tracheoesophageal-fistula and tracheo-innominate fistula. This report presents a 22-year-old man with post-intubation tracheal stenosis and tracheoesophageal fistula, following long-term intubations and simultaneous repair of tracheoesophageal fistula with a good result. The patient after care accident in comatose state was intubated and connected to ventilator for 3 weeks, 10 days after intubation, tracheostomy was performed on him. During this time, his nutrition was done by nasogastric tube. With beginning oral route nutrition, there was cough with each swallowing. In bronchoscopy there was mucosal inflammation and tracheal rings destruction in 3 cm below the vocal cords, with 2.5-3 cm in length that was accompanied by tracheoesophageal-fistula in the tracheal membranous wall. Because of dyspnea and tracheal stenosis, it was decided to resect the destructed part of the trachea and end-to-end anastomosis with fistula repair. In the presence of tracheoesophageal-fistula, correct judgment, pre and post-operative cares are the key factors in the outcome of patients. Proper calorie calculation for the patient [Enteral route] and simultaneous repair of tracheal stenosis are the secret of the success in the surgery of these patients