The Effect of Fentanyl and Ketorolac in Intravenous Patient-Controlled Analgesia on Postoperative Nausea and Vomiting and the Effect of Prophylactic Ondansetron / 대한마취과학회지

BACKGROUND: This study was performed to assess the effect of fentanyl and ketorolac in intravenous patient-controlled analgesia (IV-PCA) on postoperative nausea and vomiting and the antiemetic effect of prophylactic ondansetron after a total abdominal hysterectomy. METHODS: Of 115 women having general anesthesia for a total abdominal hysterectomy, a non-PCA group (n = 52) didn't receive IV-PCA and a PCA group (n = 39) and ondansetron group (n = 24) received IV fentanyl 1 - 1.5 microgram/kg and IM ketorolac 30 mg as a loading dose and IV-PCA with a mixture of 60 ml with fentanyl 25 - 30 microgram/kg and ketorolac 4 - 5 mg/kg. In addition, the ondansetron group received IV ondansetron 4 mg before an IV-PCA was started. We assessed nausea, vomiting and the need for rescue antiemetics during the first 24 hours postoperation. RESULTS: During the first 24 hours postoperation, there were no significant differences in the incidence of nausea, vomiting and the need for rescue antiemetics among the groups. CONCLUSIONS: Intravenous patient-controlled analgesia with fentanyl and ketorolac didn't increase postoperative nausea, vomiting and the need for rescue antiemetics during the first 24 hours postoperation. Also, prophylactic ondansetron didn't significantly reduce the chance of postoperative nausea, vomiting and rescue antiementics.

The Effects of Propofol Anesthesia or Prophylactic Droperidol on Postoperative Nausea and Vomiting in Patients Undergoing a Gynecologic Laparoscopy / 대한마취과학회지

BACKGROUND: Postoperative nausea and vomiting (PONV) is a common complication of a gynecologic laparoscopy. This study was designed to assess the effect of prophylactic droperidol 1 mg or propofol as the induction and maintenance anesthetic agent for prophylaxis of PONV in women undergoing a gynecologic laparoscopy. METHODS: Eighty ASA physical status 1, 2 patients undergoing an elective gynecologic laparoscopy were randomly allocated into four groups. Group 1 (n = 20) recieved an intravenous placebo of noraml saline 1 ml prior to induction of anesthesia and N2O-enflurane general anesthesia. Group 2 (n = 20) recieved an intravenous placebo of noraml saline 1 ml prior to induction of anesthesia and N2O-propofol general anesthesia. Group 3 (n = 20) recieved intravenous prophylactic droperidol 1 mg prior to induction of anesthesia and N2O-enflurane general anesthesia. Group 4 (n = 20) recieved intravenous prophylactic droperidol 1 mg prior to induction of anesthesia and N2O-propofol general anesthesia. RESULTS: The incidence and severity of PONV and sedation scores were assessed at 0, 30 min, 1, 3, 6, 24 and 48 hours postoperatively. The incidence of PONV was 75% in group 1, 10% in group 2, 30% in group 3 and 20% in group 4. The incidence of PONV during the first 6 hours postoperatively was 70% in group 1, 0% in group 2, 10% in group 3 and 5% in group 4 and there were no statistical differences among the four groups in the 6 to 24 hour postoperative period. Sedation scores were significantly higher in group 3 and 4 than in 1 and 2 in the 3 to 6 hour postoperative period. CONCLUSIONS: Propofol anesthesia, prophylactic droperidol 1 mg and a combination to prevent PONV were highly effective during the first 6 hours postoperatively.

The Effect of Timing of Ondansetron Administration on Nausea and Vomiting during Intravenous Patient-Controlled Analgesia / 대한마취과학회지

BACKGROUND: This study was designed to establish the optimal timing of administration of ondansetron for prevention of postoperative nausea and vomiting (PONV) during intravenous patient-controlled analgesia (IV-PCA). METHODS: Eighty women undergoing a total abdominal hysterectomy under general anesthesia were randomized to receive a placebo (n = 20, group 1), ondansetron 2 mg before induction and 2 mg after surgery (n = 20, group 2), ondansetron 4 mg before induction (n = 20, group 3), or ondansetron 4 mg after surgery (n = 20, group 4). An IV-PCA using butorphanol and ketorolac was connected to the patients after waking from the anesthesia. The incidences and severity of nausea and vomiting were recorded for 48 hr postop. RESULTS: The incidences of nausea and vomiting in group 1 (75%, 40%) were significantly decreased after ondansetron administration but there were no significant differences among the ondansetron groups (group 2; 45%, 20%, group 3; 45%, 15%, group 4; 40%, 10%) (P < 0.05). CONCLUSIONS: The prophylactic administration of ondansetron is effective in preventing PONV during IV-PCA, but the timing of ondansetron administration has no effect on its efficacy.

Postoperative Antiemetic Effect of Ondansetron and Droperidol in Female Patients Undergoing Breast Surgery / 대한마취과학회지

BACKGROUND: Postoperative nausea and vomiting (PONV) is one of the most common complications following surgery performed under general anesthesia, especially in female patients. A reduction of PONV would improve the overall satisfaction of patients with their hospital experience and the quality of patient care. We have compared the efficacy of ondansetron to droperidol and saline in the prevention of PONV in 90 ASA 1 and 2 patients undergoing breast surgery. METHODS: Patients were randomly divided into four groups to receive pretreatment with a placebo 20 ml, droperidol 1.25 mg and ondansetron 4 mg, or 8 mg. Postoperatively, all episodes of PONV experienced by the patients during the first 24 hours after anesthesia were recorded by study personnel without knowledge of which antiemetics the patients had received. RESULTS: There was no significant difference in the incidence of PONV between the four groups. No major adverse effects were observed in the ondansetron or droperidol groups. CONCLSIONS: The present study demonstrates that droperidol 1.25 mg, ondansetron 4 mg, or 8 mg IV are not superior to a placebo IV in preventing PONV after breast surgery.

Antiemetic Efficacy of Prophylactic Ondansetron in Gynecologic Patient Using Patient-Controlled Analgesia after Surgery / 대한마취과학회지

BACKGROUND: Postoperative nausea and vomiting remain troublesome problems, especially in women receiving the opioid analgesics. This study was performed to assess the antiemetic efficacy of ondansetron in patients using an intravenous patient-controlled analgesia (IV-PCA) after gynecologic surgery. METHODS: In this randomized placebo-controlled study, forty healthy gynecologic surgical patients received ondansetron 4 mg or placebo at the end of surgery. Patients in the recovery room received fentanyl by PCA which provided a bolus dose of 20 microgram, a lockout time of 6 minutes, and a basal infusion of 20 microgram/hr. We assessed the occurrence of nausea, vomiting, and the need for rescue antiemetics during the first 24 hours after operation. RESULTS: During the first 24 hr after operation, 40% of patients experienced no nausea or vomiting in the ondansetron group compared to 30% of patients in the placebo group. There was no significant difference in the incidence of nausea between groups (70% in placebo group vs 60% in ondansetron group). However, ondansetron reduced the incidence of vomiting from 50% to 15%, and the need for rescue antiemetics significantly from 25% to 0% (P< 0.05). CONCLUSIONS: Ondansetron in a dose of 4 mg does not prevent postoperative nausea during the first 24 hours after operation when used with fetanyl PCA. However, ondansetron significantly reduces the chance of postoperative vomiting and rescue antiemetics.

Effect of Propofol on the Incidence of Postoperative Nausea and Vomiting after Minor Orthopedic Surgery / 대한마취과학회지

BACKGROUND: The aim of the present study is to evaluate the effect of propofol on the incidence of postoperative nausea and vomiting (PONV) during the first 24 hours after minor orthopedic surgery using general anesthesia. METHODS: We studied 66 healthy female patients (aged 20-67 years old). The patients were randomly divided into the two groups: (i) Group P (n=33): Anesthesia was induced with propofol and fentanyl, and maintained with continuous infusion of propofol. (ii) Group E (n=33): Anesthesia was induced with thiopental and fentanyl, and maintained with enflurane. We compared the incidence and severity of PONV at 6 and 24 hours after the operation between the two groups. RESULTS: The incidence and severity of PONV in Group P was significantly lower than in Group E during the first 6 hours after the operation (p<0.05). However, after 6 hours, there was no significant differences between the two groups. CONCLUSION: In the early postoperative period, the use of propofol prevents PONV.

The Effect of Metoclopramide and Ondansetron on Postoperative Nausea and Vomiting Following Propofol Injection as Induction Agent in Laparoscopic Surgery / 대한마취과학회지

BACKGROUND: Postoperative nausea and vomiting (PONV) are common problems in patients undergoing outpatient laparoscopy and hysteroscopy. Associated complications range in severity from mild discomfort to hospital admission for dehydration or pulmonary aspiration. This study was designed to assess the efficacy of 2 antiemetics (metoclopramide and ondansetron) with propofol as the induction agent for prophylaxis of postoperative emesis in women undergoing general anesthesia for gynecologic endoscopic surgery. METHODS: One hundred and twenty six healthy women undergoing laparoscopic and hysteroscopic surgery with general anesthesia were randomized to receive intravenous bolus of saline 2 ml, metoclopramide 10 mg, ondansetron 4 mg prior to induction of anesthesia. Anesthesia was induced with propofol 2~2.5 mg/kg, vecuronium 0.1 mg/kg and maintained with O2, N2O, enflurane, fentanyl 1~2 microgram/kg. The incidence of nausea and vomiting was assessed at recovery room and all patients were contacted 24 hours after discharge. RESULTS: The incidence of PONV showed 11.9% in control group, 11.9% in metoclopramide group and 9.5% in ondansetron group in recovery room. The incidence of PONV showed 14.3% in control group, 14.3% in metoclopramide group and 7.1% in ondansetron group in 24 hours postoperatively. There were no significant differences among the groups. CONCLUSIONS: When propofol was administered by intravenous induction agent, no antiemetic in this study was more efficacious than propofol alone in reducing PONV for women undergoing outpatient laparoscopic and hysteroscopic surgery.

Influence of Droperidol on Postoperative Nausea and Vomiting during Patient-Controlled Analgesia with Fentanyl / 대한마취과학회지

INTRODUCTION: Patient-controlled analgesia (PCA) has become an important means for postoperative analgesia with parenteral opioid, but postoperative nausea and vomiting (PONV) remains a major problem using a PCA system. The present study was designed to assess the antiemetic effectiveness of droperidol in patients using an intravenous PCA during the first 24 hours after surgery. METHODS: For the postoperative analgesia, 80 patients underwent orthopedic surgery were randomly allocated to receive PCA with either a mixture of 3.75 mg droperidol and fentanyl 2500 microgram after initial bolus of 1.25 mg droperidol as the FD group, or a mixture of saline and fentanyl 2500 microgram as the FS group at the end of surgery. RESULTS: The incidence of PONV showed 52.5% in FS group and 15% in FD group respectively (P<0.05). The incidence of PONV was 2~3 times more in women (76% in FS group & 25% in FD group) than men (35% in FS group & 9% in FD group). CONCLUSION: The addition of droperidol to fentanyl in a PCA system reduces the PONV during the first 24 hours after surgery.

Comparison of Isoflurane and Propofol Anesthesia on Postoperative Nausea, Vomiting and Recovery after Tonsillectomy in Children / 대한마취과학회지

BACKGROUND: The purpose of this study was to compare prospectively two different anesthetic techniques with isoflurane or propofol for postoperative nausea, vomiting and recovery after tonsillectomy in children. METHODS: Sixty children, ASA physical status I, were assigned randomly to one of two groups. In group I, anesthesia was induced with thiopental 5 mg/kg and maintained with isoflurane 1~1.5 vol%. In group P, anesthesia was induced with fentanyl 1 mcg/kg, propofol 2 mg/kg and maintained with propofol infusion 5~10 mg/kg/hr. Both group received vecuronium 0.1 mg/kg for tracheal intubation and were ventilated with 33% O2 in N2O. The time to extubation, time to eye opening, PACU time, incidence and numbers of postoperative nausea and vomiting, and degree of sedation were recorded as well as perioperative complications. RESULTS: There were no significant difference in the duration of anesthesia and PACU time between two groups. The time to extubation and eye opening of group P were significantly shorter than group I (p<0.05). The degree of sedation and incidence of postoperative nausea and vomiting of group P were significantly lower than group I (p<0.05). But the frequency of intraoperative bradycardia was significantly higher in group P than group I (p<0.05). CONCLUSIONS: Propofol-fentanyl anesthesia results in less nausea and vomiting during postoperative period and more rapid recovery compared to isoflurane anesthesia and may be recommended in children undergoing tonsillectomy and adenoidectomy.

Changes in Airway Pressure, Blood Gas and Postoperative Emesis of 50% N2O in Laparoscopic Cholecystectomy / 대한마취과학회지

BACKGROUND: The use of laparoscopic techniques in general surgery has gained increasing popularity. The small, limited incisions are well accepted by patients and there is the benefit of a faster recovery. But the contribution of N2O to nausea and vomiting is still controversial. This study was undertaken to evaluate the effect of N2O for airway pressure, blood gas and postoperative emesis in laparoscopic cholecystectomy. METHODS: Twenty ASA physical status I, II patients for elective laparoscopic cholecystectomy were randomly divided into two groups. First group (n=10) of patients was anesthetized with isoflurane(0.5~1.5 vol%)-O2 (2 l/min)-air (2 l/min). Second group (n=10) of patients was anesthetized with isoflurane (0.5~1.5 vol %)-O2 (2 l/min)-N2O(2 l/min). After induction of anesthesia, ventilation was controlled with tidal volume 10 ml/kg and respiratory rate 11/min and not changed throughout the operation. After measuring of control value of PaCO2, pH and airway pressures before CO2 insufflation, repeatedly measured at 20 min, 40 min after CO2 insufflation and 10 min after CO2 exsufflation. We observed the patients concerning nausea and vomiting for postoperative period. RESULTS: There were no significant intraoperative differences between the both groups with respect to PaCO2, pH and airway pressures. In the both groups, PaCO2 and airway pressure throughout the operation are significantly increased in comparison to control values. The pH is significantly decreased in comparison to control values. The incidence of postoperative nausea and vomiting was similar in both groups. CONCLUSIONS: N2O had no clinically apparent effects on airway pressure, blood gas and postoperation emesis during laparoscopic cholecystectomy.