Effect of dexamethasone with granisetron or ondansetron for prevention of post-operative nausea vomiting in patients undergoing laparoscopic gynaecological surgery

Background: Post-operative nausea and vomiting (PONV) is generally self-limiting, associated with high level of patient dissatisfaction and may delay hospital discharge. The anaesthetist is usually blamed, despite evidence that PONV results from a variety of factors and variety of antiemetic drug available in market. With this issue we aim to compare the effectiveness of dexamethasone with granisetron or ondansetron in patients undergoing laparoscopic gynaecological surgery.Methods: 120 patients were registered in this prospective, randomized double blind study. Group I (n=60) received ondansetron 4 mg intravenously (IV)+dexamethasone 8mg I/V or II (n=60) received granisetron 1 mg IV+dexamethasone 8 mg I/V prior to anaesthesia. Post-operative data of PONV was recorded at pre-defined intervals.Results: The majority of the patients were of the age group 20-25 years (55.83%). The mean score of Group I subjects was 0.30±0.72 and that of Group II was 0.20±0.57 (p=0.43).  There are 3.33% of patients in group-I having vomiting episodes, and 1.67% of patients in group-II having vomiting episodes, none of the patients developed 2nd episodes of vomiting in either group. Thus it appears that dexamethasone in combination with ondansetron and granisetron is effective in decreasing the number of episodes of PONV. The occurrence of sickness episodes within 24 hours of surgery revealed no significant different in both groups. Haemodynamic variables showed no significant difference recorded in postoperative care unit between the study groups. The most common complaint was headache 16.67% in both groups.  Conclusions: Dexamethasone 8 mg with either granisetron 1 mg or ondansetron 4 mg showed no significant difference in antiemetic efficacy with minimal side effects and excellent patient satisfaction.

Risk factors associated with antineoplastic chemotherapy-induced nausea and vomiting / Fatores de risco associados a náuseas e vômitos induzidos por quimioterapia antineoplásica

ABSTRACT OBJECTIVE: To estimate the incidence and to evaluate risk factors for antineoplastic nausea and vomiting with high and moderate emetogenic chemotherapy in adult patients in the first treatment cycle. METHODS: Prospective cohort study with follow-up of 269 adults during the first cycle of antineoplastic chemotherapy. The incidence of nausea and vomiting was evaluated in the acute phase (0-24 hours), in the late phase (24 hours-5th day) and in the total phase (0-5th day). RESULTS: In total, 152 patients underwent high emetogenic chemotherapy and 117 moderate emetogenic chemotherapy. The relative frequency of nausea was higher when compared with vomiting in the acute phase (p < 0.001) and in the late phase (p < 0.001). The risk factors identified were: age group ≤ 49 years (odds ratio = 0.47; 95%CI 0.23-0.95) and 50-64 years (odds ratio = 0.45; 95%CI 0.23-0.87), tobacco use (odds ratio = 0.35; 95%CI 0.14-0.88), and high emetogenic chemotherapy (odds ratio 0.55; 95%CI 0.31-0.95). CONCLUSION: The incidence of nausea was higher than that of vomiting, and adverse effects were more frequent in the late phase. The results suggest the risk factors for chemotherapy-induced nausea and vomiting are tobacco, age (young adults), and high emetogenic chemotherapy.

RESUMO OBJETIVO: Estimar a incidência e avaliar os fatores de risco para náuseas e vômitos induzidos por antineoplásicos com alto e moderado potencial emético em pacientes adultos, no primeiro ciclo de tratamento. MÉTODOS: Estudo de coorte prospectiva, com 269 adultos acompanhados durante o primeiro ciclo de quimioterapia antineoplásica. A incidência de náuseas e vômitos foi avaliada na fase aguda (0-24 horas), na fase tardia (24 horas-5° dia) e na fase total (0-5° dia). RESULTADOS: 152 pacientes foram submetidos a quimioterápico com alto potencial emético e 117 a moderado potencial emético. A frequência relativa de náuseas foi maior quando comparada à de vômitos na fase aguda (p < 0,001) e na fase tardia (p < 0,001). Os fatores de risco identificados foram: faixa etária ≤ 49 anos (odds ratio = 0,47; IC95% 0,23-0,95) e 50-64 anos (odds ratio = 0,45; IC95% 0,23-0,87), uso de tabaco (odds ratio = 0,35; IC95% 0,14-0,88) e alto potencial emético dos quimioterápicos (odds ratio 0,55; IC95% 0,31-0,95). CONCLUSÃO: A incidência de náuseas foi maior do que a de vômitos, e na fase tardia os efeitos adversos foram mais frequentes. Os resultados sugerem que os fatores de risco para náuseas e vômitos induzidos por quimioterapia são o tabaco, a idade (adultos jovens) e o alto potencial emético do quimioterápico.

Gabapentin Versus Dexamethasone for Prophylaxis of Post-Operative Nausea and Vomiting in Patients Undergoing Laparoscopic Cholecystectomy

Post-operative nausea and vomiting (PONV) is one of the commonest complications in anaesthesia accounting for 20-30% cases but number may rise to 70% in laparoscopic surgeries.1,2 Laparoscopic cholecystectomy is carried out as day care surgery but PONV prolongs hospital stay. Several studies have documented role of Gabapentin and Dexamethasone for prophylaxis of PONV but none has compared them for the same. This study aimed at comparing the efficacy of oral gabapentin and dexamethasone for prophylaxis of PONV and need for rescue anti-emetics in first 24 hours. Methods: This prospective, single blind randomized trial enrolled 100 ASA physical status I and II patients assigned into two groups: Group G (Gabapentin group, n=50) received 600 mg of Gabapentin oral formulation with sip of water on the morning of surgery whereas Group D (Dexamethasone group, n=50) received 8 mg of Dexamethasone oral formulation with sip of water on the morning of surgery. Following parameters were noted: time to first rescue anti-emetic drug (Injection Ondansetron), total number of rescue anti-emetic doses, complications if any. Results: The two groups i.e the Gabapentin group and the dexamethasone group were comparable with regards to the demographic profile (age, weight and sex). However the mean duration of surgery was more in Gabapentin group compared to Dexamethasone group, the difference being statistically significant (P< 0.05). Time between extubation and first rescue antiemetic was also comparable in the two groups the results being statistically non significant (P > 0.05). The mean of total number of rescue antiemetics in 24 hours as well as grading of Wilsons score for PONV in the two groups was also statistically non significant (P > 0.05). Conclusion: Both the drugs gabapentin and dexamethasone are equally effective in preventing postoperative nausea and vomiting.

Comparsion of Palonsteron, Ondansetron and Dexamethasone in Reduction of Post Operative Nausea and Vomiting Following Laparoscopic Cholecystectomy

The aim of the study is to compare efficacy of intravenous (i/v) Palonosetron (75mcg), i/v Ondansetron (4mg) and i/v Dexamethasone (5mg) as prophylactic agents for reducing post-operative nausea and vomiting that follows laparoscopic cholecystectomy. Methods: This prospective randomized double blind study was conducted in the Department of Anaesthesia and Critical Care, Tata Main Hospital, Jamshedpur. The study participants comprised of patients undergoing elective laparoscopic cholecystectomy surgeries under general anaesthesia. A total of 90 patients i.e. 30 in each of the three groups were enrolled for the study. Enrolled patients were randomly allocated to received with i/v Dexamethasone (5 mg) or i/v Ondansetron (4mg) or i/v Palonosetron (0.075 mg). The patients in the three groups were monitored and symptoms charted on basis of Post Operative Nausea and Vomiting (PONV) scale. Results: Palonosetron 0.075mg single intravenous dose given prior to induction of anaesthesia achieves 100% complete response with 3.33% reported side effect, and none needed rescue antiemetic. Dexamethasone 5mg single intravenous dose given prior to induction of anaesthesia achieves 93.33 % complete response with none reporting side effect and 6.67% needing rescue antiemetic. Ondansetron 4mg single intravenous dose given prior to reversal of neuromuscular blockade achieves 66.67 % complete response with 20% reporting side effect and 33.33 % needing rescue antiemetic. Conclusion: I.V. Palonosetron and Dexamethasone are equally potent and superior antiemetics than Ondansetron in the prevention of PONV in patients undergoing elective laproscopic cholecystectomy under general anaesthesia.

The clinical analyses of neuromyelitis optica spectrum disorder initially presenting with area postrema syndrome in 14 patients / 中华内科杂志

Objective To explore the clinical characteristics of the neuromyelitis optica spectrum disorders (NMOSD) with the area postrema syndrome as the initial symptom.Methods A total of 14 cases were enrolled in the study with the diagnose of NMOSD and the area postrema syndrome as the initial symptom.All the clinical data and imaging profiles by the contrasted magnetic resonance imaging (MRI) of the head and spinal cord were collected and analyzed.Results The median age of onset was (38.1 ± 17.0)years old and the gender ratio of female to male was 10:4.The serum aquaporin-4 (AQP4)-IgG was positive in 11 subjects and several autoimmune antibodies was positive in 7 subjects.The lesions revealed by MRI of the head mainly located in the area postrema and ependymal periphery which often presented as the linear medullary lesion,while linear lesions over three pieces of vertebra were shown by MRI of the spinal cord which mainly in the grey matter and with aH shape around the spinal central canal.Misdiagnose happened in 11 subjects with seven of gastroesophageal reflux disease,two of neurogenic vomiting,one of spinal cord tuberculosis and one of stroke.Conclusions NMOSD should be considered in patients with unexplained intractable nausea,vomiting and/or hiccups lasted for 48 hours or above,especially in those with positive nervous signs.Contrasted MRI and serum AQP4-IgG need to be performed in the suspected patients.Early detection is crucial for patients with NMOSD.

Pain degree of three different incisions and relationship between incisions local infiltration and nausea-vomiting in patients receiving LC / 中国内镜杂志

Objective To discuss the pain degree of the three different incisions (subxiphoid, navel, right abdomen) and the relationship between incisions local infiltration and nausea-vomiting after Laparoscopic Cholecystectomy (LC). Methods 100 patients (ASA I) scheduled for elective surgery were randomly divided into 5 groups (n = 20): Subxiphoid Group (Group A), Navel Group (Group B), Right Abdomen Group (Group C), All Incisions Group (Group D) and Control Group (Group E). Before the incisions were sutured, patients in Group A, Group B and Group C received incisions local infiltration of Ropivacaine (0.5％, 3 ml) in subxiphoid, navel and right abdomen. Patients in Group D received incisions local infiltration of Ropivacaine (0.5％, 3 ml) in all the three incisions. Patients in Group E received saline with the same volume (3 ml) in all the three incisions. The Visual Analogue Scale (VAS) pain scores were recorded when the patients left the operating room, 2 hours, 4 hours, 8 hours, 16 hours and 24 hours after the operation. The circumstances of nausea-vomiting were also recorded. Results Demographic parameters were similar among groups. The VAS pain scores declined with time gone by. The VAS pain scores:Group A< Group D < Group C < Group B < Group E (F = 7.16, P = 0.000). Comparison between groups: The VAS pain scores in Group A and Group D were significantly less than these in Group C and Group B. The VAS pain scores in Group C and Group B were significantly less than these in Group E. There is a difference among all the groups about the percentages of nausea-vomiting. The percentages of Group B were significantly less than these in the other 4 Groups (χ2 = 10.39, P = 0.034). Conclusions The pain of the subxiphoid incision was the most severe pain in the patients receiving LC. Compared with the other two incisions local infiltration, subxiphoid incision local infiltration proved to be the most effective treatment in reducing the VAS pain scores in patient receiving LC. Navel incision local infiltration proved to be the most effective treatment in reducing the percentages of nausea-vomiting after LC.

Comparison of Ondansetron Used Alone and in Combination with Dexamethasone as a Prophylaxis for Postoperative Nausea and Vomiting Following Laparoscopic Cholecystectomy.

Postoperative nausea and vomiting (PONV) is common after anaesthesia and surgery. In patients undergoing laparoscopic cholecystectomy (LC) without antiemetic prophylaxis, the incidence can be as high as 76% which would cause unexpected delay in hospital discharge. This study was designed to compare the efficacy of the ondansetron alone with combination of ondansetron and dexamethasone the given as prophylaxis for PONV in patients undergoing laparoscopic cholecystectomy. One hundred patients undergoing elective laparoscopic cholecystectomy were selected and randomly divided into 2 groups of 50 each. Group I received 4mg of ondansetron intravenously (iv), whereas Group II received ondansetron 4mg and dexamethasone 4mg just before induction of anaesthesia. Postoperatively, the patients were assessed for episodes of nausea, vomiting and need for rescue antiemetic. Complete response defined as no nausea and vomiting during first 24 hours, was noted in 76% of patients in Group I and in 92% of patients in Group II. Rescue anti emetic requirement was less in Group II (4%) than Group I (20%). So it can be concluded that the combination of ondansetron and dexamethasone is more effective in preventing PONV in patients undergoing laparoscopic cholecystectomy than ondansetron alone.

Effect of Acupressure on Nausea-vomiting and Weight Change among Pediatric Cancer Patients Receiving Anti-cancer Chemotherapy / 아동간호학회지

PURPOSE: This study was to confirm the effect of acupressure on the emesis control and the weight change among pediatric cancer patients receiving anti-cancer chemotherapy. METHOD: Forty pediatric cancer patients, receiving the induction stage of chemotherapy with MTX and vincristine, were divided into control(n=20) and the intervention group(n=20). Both groups received regular anti-emesis medication, but the intervention group was added acupressure maneuver for 5 minutes on P6 point for 3 times a day for 5days: before chemotherapy, lunch and dinner by investigator during the hospitalization and by mother at home. The instruments for this study were Rhode's(1986) Index of nausea, vomiting and retching(INVR), Cas electric scale and pamphlet developed by researcher. RESULT: Significant differences in the degree of nausea and vomiting were observed between the control and the intervention group as measured by INVR(t=4.73; p=.01). Repeated measures ANOVA also shows that the group effect was significant(F=22.39, P=.01) as was the time effect(F=380.35, P=.01). The group by time interaction was also significant(F=5.27, P=.01). Acupressure maneuver was apparently effective in reducing the degree of chemotherapy-induced nausea and vomiting. There were also statistically significant weight loss noted in the control group than the intervention group(t=5.42, p=.01). CONCLUSION: Acupressure on P6 point shows an effective adjunct maneuver in reducing the degree of nausea and vomiting and conserving the weight in pediatric cancer patients. Therefore, it is proposed that acupressure should be applied as supportive nursing intervention strategies to relieve chemotherapy induced nausea and vomiting and to prevent weight loss in pediatric cancer patients.

Effects of Aroma Oil Inhalation on Nausea Vomiting and Anorexia in Cancer Patients Receiving Chemotherapy / 성인간호학회지

PURPOSE: The purpose of this study was to examine the effects of aroma oil inhalation using peppermint and bergamot on nausea vomiting and anorexia in cancer patients receiving chemotherapy. METHOD: Study subjects were 30 patients who had experienced nausea and vomiting when they had been hospitalized in K university hospital located in D city after receiving more than two Cisplatin combination chemotherapy treatments. Among them 15 patients were in the experimental group doing aroma oil inhalation and the other 15 patients were in the control group without aroma oil inhalation. The data were collected from February 1, 2002 to May 17, 2002. The data were analyzed with SPSS WIN 10.0 program using frequency, percentage, chi-square-test, t-test, Repeated Measures ANOVA. RESULTS: 1) The degree of nausea and vomiting in the experimental group with aroma oil inhalation using peppermint and bergamot were significantly lower than that of the control group. 2) The degree of anorexia in the experimental group with aroma oil inhalation using peppermint and bergamot were significantly lower than that of the control group. CONCLUSION: aroma oil inhalation was effective for relieving patients' nausea vomiting and anorexia receiving chemotherapy. Therefore, it is proposed that aroma oil inhalation should be applied as a supportive nursing arbitration method to relieve patients' nausea vomiting and anorexia who are receiving chemotherapy.

Effects of Aroma Oil Inhalation on Nausea Vomiting and Anorexia in Cancer Patients Receiving Chemotherapy / 성인간호학회지

PURPOSE: The purpose of this study was to examine the effects of aroma oil inhalation using peppermint and bergamot on nausea vomiting and anorexia in cancer patients receiving chemotherapy. METHOD: Study subjects were 30 patients who had experienced nausea and vomiting when they had been hospitalized in K university hospital located in D city after receiving more than two Cisplatin combination chemotherapy treatments. Among them 15 patients were in the experimental group doing aroma oil inhalation and the other 15 patients were in the control group without aroma oil inhalation. The data were collected from February 1, 2002 to May 17, 2002. The data were analyzed with SPSS WIN 10.0 program using frequency, percentage, chi-square-test, t-test, Repeated Measures ANOVA. RESULTS: 1) The degree of nausea and vomiting in the experimental group with aroma oil inhalation using peppermint and bergamot were significantly lower than that of the control group. 2) The degree of anorexia in the experimental group with aroma oil inhalation using peppermint and bergamot were significantly lower than that of the control group. CONCLUSION: aroma oil inhalation was effective for relieving patients' nausea vomiting and anorexia receiving chemotherapy. Therefore, it is proposed that aroma oil inhalation should be applied as a supportive nursing arbitration method to relieve patients' nausea vomiting and anorexia who are receiving chemotherapy.

Clinical Analysis of Internal Orbital Fractures in Children

In order to describe the demographics, etiologic and clinical factors, and outcomes of orbital fractures in children, we have reviewed a case series of 17 patients under 18 years of age with internal orbital fractures (i.e., without involvement of the orbital rim) presenting to the Ghil hospital between March 2000 and June 2001. For 15 of the patients, we performed orbital wall reconstruction with Medpor (R) barrier sheet implantation (thickness 1mm) through transconjunctival approach under endoscopic guidance, while maintaining mere observation on the other 2 patients. There were 14 male and 3 female patients. The most common cause of fractures was accident (7 cases). Inferior wall involvement was most commonly seen, and the trapdoor type fracture was the most common. Thirteen patients had extraocular muscle restriction, 9 had nausea/vomiting and 5 had bradycardia. Diplopia of 9 patients disappeared after 43+/-23 days. Nausea/vomiting and bradycardia disappeared rapidly after surgical intervention in all cases. These results suggest that trapdoor fractures with soft tissue entrapment are the most common in pediatric orbital wall fractures, and that most of them are associated with nausea/vomiting. We suggest that early diagnosis, and prompt surgical intervention are required for those patients with oculocardiac reflex.

The Nutritional Status of the Patients with Cancer during the Chemotherapies / 간호학회지

PURPOSE: The purpose of this study was to determine the changing patterns of nausea, vomiting, anorexia and calorie intake. To examine the influence of those variables on the nutritional status of the cancer patients receiving chemotherapy. METHOD: To assess nutritional status, anthropometry and blood test were performed on 94 stomach cancer patients receiving postoperational chemotherapy on the daily basis. NVA and calorie intake were measured during chemotherapy. RESULT: 93% of subjects had low level of hemoglobin and 45.7% was below the lymphocyte count. 57% of subjects lost 10% of usual weight. The value of anthropometry was reduced but the difference between pre- and post-chemotherapy did not reach any statistical significance. 27% of subjects was grouped into the malnutritional state. During chemotherapy, the higher the degree of NVA, the less calorie intake. The significant predictors for nutritional status were nausea and calorie intake. CONCLUSION: The chemotherapy affected the food intake of cancer patients through NVA. Though the influence of chemotherapy on anthropopmetry was not significant in this research, nausea and food intake were the most affecting factors for nutrition of cancer patients. Therefore we need to assess nutritional status and support for cancer patients receiving chemotherapy and to develop an intervention for improvement of symptoms and food intake.

A Study on the Effect of Oral Cryotherapy on Nausea Vomiting and Oral Intake by Anti Cancer Chemotherapy in Pediatric Cancer Patient / 아동간호학회지

This research objected to the diagnosed patients as acute lymphoblastic leukemia, acute myelogenous leukemia, neuroblastoma, non- Hodgkins lymphoma, Hodgkin's disease, kidney tumor, myelodysplastic syndrom and juvenile chronic leukemia after admission in the "P" hospital in Pusan from Aug. 1. 1999 to Jan. 31. 2000. The results of this study are summarized as follows. 1. On the specific character between the experimental(exp.) group and the control (con.) group : there were 7 of 4-7 years old patients(the most) in the experimental group(53.8%), 5 of 12 years old or older patients in the control group (38.5%). Patients who experienced operation were 7 in the exp. group(53.8%) and 6 in con. group(46.2%). The largest number of the patients' diagnosis was acute lymphoblastic leukemia by 5 in the exp. group(38.5%) and 4 in the con. group (30.8%). The hardest nausea came on the second day by 5 in the exp. group(38.5%), 9 in the con. group(69.2%). 2. P-score of the nausea vomiting on the number of daily anticancer drug administration : first day, the exp. group got 9.6 and the con. group 17.6(P = 0.03). 2nd day, 10.9 and 19.4(P = 0.00), 3rd day, 10.6 and 18.3(P = 0.00), 4th day 10.0 and 18.0, 5th day 10.9 and 16.8(P = 0.05). The score showed statistically significant difference(P < .05). 3.Oral intake didn't show statistically significant difference between two groups. However the average of Oral intake of the exp. group was continually higher than the con. group except to the first day after administration. In conclusion, nursing intervention and nutrition care are much more needed on the 2-3th day after administration to reduce nausea vomiting, and for remission of nausea and enlarging oral intake it is utilizable to apply the easy, economic Oral Cryotherapy to the young patients who undergo chemotherapy.

The Relationship of Anorexia, Nausea, Vomiting, Oral Intake and Nutritional Status in Patients Receiving Chemotherapy / 간호학회지

Malnutrition is a common problem in cancer patients. In addition anticancer drugs used in chemotherapy as a major therapeutic mode are famous as the side effect like nausea, vomiting, which lead the patients to malnourished state. This study was to determine the relationship of anorexia, nausea, vomiting and oral intake and identify the influence these side effects on the nutritional status in patients receiving chemotherapy. To assess the nutritional status, anthropometry such as weight, height, body mass index(BMI), body fat proportion, and triceps skinfold thickness, and biochemistry test such as hemoglobin and lymphocyte were measured at the pre- and post- chemotherapy and the readmission time, all three times. During chemotherapy, anorexia, nausea, and vomiting using a VAS or 5-point scale and 24 hour oral intake using a food record were measured daily. Forty-nine patients knowing their diagnosis and receiving chemotherapy were recruited from an oncological ward in a general hospital for 5 months and they were reduced 31 at readmission time for a next chemotherapy. The results were as follows. Most subjects (93.6%) were in the 4th stage of cancer and 57.1% of subjects were in the first or the second chemotherapy. In most subjects(82.6%), their weight was decreased 10.7% than as usual. The degree of anorexia, nausea, and vomiting was significantly higher and the amount of oral intake was significantly less during the chemotherapy than at the pre-chemotherapy. Weight, BMI, triceps skinfold were reduced more at the post- chemotherapy than the pre-chemotherapy and were recovered the nearly same but less level at the readmission time. Body fat proportion was increased at the post chemotherapy and then decreased at the readmission phase. Hemoglobin and the number of lymphocyte were below normal at the pre-chemotherapy and more reduced at the readmission time. Anorexia, nausea, and vomiting were related positively and oral intake was negatively related with nausea and vomiting. The nutritional status at the post- chemotherapy and the readmission time was explained 20% over by the side effect like anorexia, nausea, vomiting and oral intake during the chemotherapy. The significant nutrition predictors at the post- chemotherapy were vomiting and the significant predictors at the readmission time were anorexia, vomiting, and oral intake. These results indicated the patients receiving chemotherapy were continued to deteriorate the nutritional status. Therefore nurse should have knowledge how much the nutritional status can be affected and assess the nutritional status periodically and try to find out the intervention for side effects from the series of chemotherapies.

The Effect of Dexamethasone Combined with Ondansetron on Antiemesis and Analgesia during Postoperative Patient Controlled Analgesia / 대한마취과학회지

BACKGROUND: The purpose of this study was to compare the effectiveness of ondansetron plus dexamethasone versus ondansetron alone in the prevention of postoperative nausea and vomiting for the patient using a patient controlled analgesia (PCA). METHODS: Of sixty women having general anesthesia for total abdominal hysterectomy (TAH), thirty received intravenous ondansetron 4 mg plus 150 microgram/kg of dexamethasone (Group 1) and thirty received intravenous ondansetron 4 mg plus saline 2 ml (Group 2) after awakening. Butorphanol 10 mg, ketorolac 180 mg and ondansetron 4 mg were connected to PCA pump for postoperative pain control. The severity of nausea, vomiting and pain were assessed at 0, 1, 2, 6, 12, 24, 36 and 48 hr after awakening. RESULTS: Nausea and vomiting occurred in 5 patients in Group 1 and in 4 patients in Group 2. There were no significant differences between groups in nausea, vomiting and pain scores. CONCLUSIONS: The combination of ondansetron and dexamethasone is not more effective than ondansetron alone in prevention of postoperative nausea, vomiting and pain for women having PCA following TAH.

A Comparison of the Antiemetic Effect of Ondansetron and Metoclopramide on Nausea and Vomiting Associated with Epidural Buprenorphine / 대한마취과학회지

BACKGROUND: Epidural buprenorphine provides good pain relief after Cesarean section, but is often associated with nausea and vomiting. Ondansetron, a selective 5-hydroxytryptamine 3 (5-HT3) receptor antagonist, is known to prevent and treat emesis after chemotherapy in cancer patients and after general anesthesia. The purpose of this study was to compare the prophylactic antiemetic effect of ondansetron and metoclopramide on nausea and vomiting after epidural buprenorphine. METHODS: Sixty women undergoing Cesarean section were studied. The patients were given subarachnoid injections of 0.5% tetracaine 9 mg and were inserted with epidural catheters for postoperative pain control. Prior to closure of the peritoneum, we injected a mixture of buprenorphine and bupivacaine through the epidural catheters and gave intravenous boluses of saline 6 ml, metoclopramide 10 mg and ondansetron 4 mg randomly. The incidence of nausea and vomiting and the degree of satisfaction were evaluated until 24 hr after the injection of epidural buprenorphine. RESULTS: The number of patients who became nauseated or vomited did not differ significantly between the ondansetron group and the metoclopramide group. Also, subjective ratings of satisfaction and incidence of other side effects did not differ significantly between the groups. CONCLUSIONS: Ondansetron, administered intravenously, prevented postoperative nausea and vomiting associated with epidural buprenorphine equally as well as metoclopramide.

A Comparison of the Effects of Ondansetron and Granisetron on the Prevention of Postoperative Nausea and Vomiting after Gynecologic Surgery / 대한마취과학회지

BACKGROUND: The purpose of this study was to compare the effects of ondansetron and granisetron on the prevention of postoperative nausea and vomiting (PONV) in gynecologic patients. METHODS: In a randomized placebo-controlled study, 200 gynecologic patients were divided into 5 groups. Each patient received one of 5 medications: placebo (saline 3 ml), ondansetron 4 mg (O4), ondansetron 8 mg (O8), granisetron 1.5 mg (G1.5) and granisetron 3 mg (G3). They were administered intravenously immediately before the induction of anesthesia. A standardized inhalation anesthesia and a postoperative intravenous patient-controlled analgesia were applied. Twenty four hours after anesthesia, the incidence and severity of PONV and other adverse effects were assessed. RESULTS: The incidence of PONV was 88%, 83%, 75%, 70% and 60% in the placebo, O4, O8, G1.5 and G3 groups, respectively, which showed significantly lower value in the G3 group than in the placebo and O4 groups (P< 0.05). The severity of PONV was also significantly lower in the G3 group than in the placebo group (P < 0.05). CONCLUSIONS: In this study, granisetron 3 mg showed a better prophylactic effect in the mitigation of PONV in gynecologic patients then a placebo or ondansetron 4 mg.

The Antiemetic Efficacy of Prophylactic Ondansetron and Droperidol in Epidural Anesthesia / 대한마취과학회지

BACKGROUND: Ondansetron, a 5-HT3 (hydroxytryptamine receptor 3) receptor antagonist, is effective for prevention and treatment of postoperative nausea and vomiting. This study is to evaluate the intraoperative and postoperative efficacy of prophylactic ondansetron and droperidol in preventing nausea and vomiting in cesarean section patients under epidural anesthesia. METHODS: Sixty ASA physical status I-II parturients undergoing elective cesarean section under epidural anesthesia were allocated to 3 groups received intravenous ondansetron 4 mg (Group O), droperidol 1.25 mg (Group D) and normal saline 1 ml (Group N) after delivery of baby. The intra and postoperative incidence and severity of nausea and vomiting were recorded using 4 point scale (0: none, 1 : mild, 2: moderate, 3: severe). RESULTS: There were significantly lower incidence and severity of nausea and vomiting in Group O and Group D than in Group N during intra and postoperative 24 hours (p<0.05). CONCLUSIONS: Prophylactic ondansetron and droperidol had antiemetic effect in cesarean section patients under epidural anesthesia and these effect was observed long after the normal expected duration.

A Comparison of the Efficacy and Safety of Ondansetron, Droperidol and Ondansetron Plus Droperidol as Antiemetics for Elective Thyroidectomy / 대한마취과학회지

BACKGROUND: Thyroidectomy has been a surgical procedure associated with a high incidence of postoperative nausea and vomiting (PONV), and conventional antiemetics cannot prevent PONV effectively. In this study, we compared the efficacy and safety of ondansetron 70 microgram/kg, droperidol 10 microgram/kg and combination of both drugs to placebo in the prevention of PONV. METHODS: Seventy-six patients undergoing thyroidectomy were randomized to receive placebo (Group I, n=20), ondansetron 70 microgram/kg (Group II, n=19), droperidol 10 microgram/kg (Group III, n=18) and combination of both drugs (Group IV, n=19). The effects of these regimens on the incidence and severity of PONV and adverse events were analyzed for the 0 to 1 hour and 1 to 24 hours postoperative periods. RESULTS: In the 0 to 1 hour postoperative periods, the incidence of symptom free (no nausea and retching or vomiting) paients were 60% for placebo, 68.4% for ondansetron (p>0.05 versus placebo group), 88.9% for droperidol (p0.05 versus placebo group), 77.8% for droperidol (p0.05 versus placebo group), 77.8% for droperidol (p<0.05 versus placebo and ondansetron group), and 73.7% for combination of both drugs (p<0.05 versus placebo and ondansetron group). Also, there were no significant differences between the droperidol and droperidol plus ondansetron group. Among the side effects associated with antiemetics, headache and dizziness incidence was higher. CONCLUSIONS: Droperidol and combination of ondansetron plus droperidol was superior to placebo, and ondansetron for prevention of PONV during the first 24 hours postoperative period.

Effects of Transdermal Scopolamine on Postoperative Nausea and Vomiting during Patient-controlled Analgesia / 대한마취과학회지

BACKGROUND: Patient-controlled analgesia (PCA) provides excellent pain relief in the management of postoperative pain, but is associated with unpleasant side effects such as nausea and vomiting. The transdermal scopolamine patch (TSP) has been shown to have effective antiemetic actions. We evaluated the effectiveness of TSP in patients receiving morphine and fentanyl via intravenous PCA. METHODS: Sixty patients were scheduled for an elective intra-abdominal gynecologic surgery under general anesthesia, and had elected to receive intravenous PCA postoperatively. Soon after their arrival in the operating room, the patients were randomised to receive either a placebo patch (group P) or TSP (group S) on the right postauricular area. Nausea, vomiting and sedation were scored at the postoperative care unit (PACU) and at 12, 24, 48, and 72 h postoperatively. Patients were treated with metoclopramide as deemed necessary by the primary care nurse. RESULTS: No differences were found between the groups in scores and incidence of nausea and vomiting at the PACU and at 12, 24, 48, and 72 h postoperatively. The patients who received metoclopramide were significantly fewer in group S than in group P (6.7% vs 43.3%, P < 0.05). The sedation score was significantly lower in group S than in group P (1.3 0.5 vs 1.8 0.9, P < 0.05) at 12h postoperatively. CONCLUSIONS: TSP did not reduce the incidence and score of nausea and vomiting in postoperative patients during intravenous PCA. However, patients who received TSP required less antiemetic medication. TSP appears to be effective for supplemental antiemetic medication.