ABSTRACT
Context: The role of prophylaxis for postoperative nausea and vomiting (PONV) in cardiac surgery is under debate. Aims: To study the risk factors for PONV after cardiac surgery and the role of betamethasone with or without droperidol for its prevention. Setting and Design: Randomized open-label controlled study comparing standard care with PONV prophylaxis from February to November 2016. Methods: Five hundred and two patients with planned nonemergent cardiac surgery were included. Interventions: In the intervention arm, PONV prophylaxis (4 mg betamethasone with/without 0.625 mg droperidol) was administered in high-risk patients (two or more risk factors). Patients in the control arm were treated as per routine hospital practices. Results: Female sex, past history of PONV, and migraines were associated with a significantly increased risk of PONV, while motion sickness, smoking status, and volatile anesthetics were not. Pain and treatment with nefopam or ketoprofen were associated with an increased risk of PONV. PONV was less frequent in the active arm compared to controls (45.5% vs. 54.0%, P = 0.063; visual analogic scale 10.9 vs. 15.3 mm, P = 0.043). Among the 180 patients (35.6%) with ≥2 risk factors, prophylaxis was associated with reduced PONV (intention-to-treat: 46.8% vs. 67.8%, P = 0.0061; per-protocol: 39.2% vs. 69%, P = 0.0002). In multivariate analysis, prophylaxis was independently associated with PONV (odds ratio [OR]: 0.324, 95% confidence interval: 0.167–0.629, P = 0.0009), as were female sex, past history of PONV, and migraines (OR: 3.027, 3.031, and 2.160 respectively). No drug-related side effects were reported. Conclusion: Betamethasone with/without droperidol was effective in decreasing PONV in high risk cardiac surgical patients without any side effect.
ABSTRACT
BACKGROUND: This study was designed to evaluate ramosetron oral disintegrating tablet (ODT), a 5-HT3 receptor antagonist, for prophylaxis and treatment of postoperative nausea and vomiting (PONV) in patients undergoing general anesthesia using patient controlled analgesia (PCA). METHODS: 150 adult, ASA physical status I or II, aged 18-65 yr, patients undergoing elective surgery were enrolled (n = 50 in each). Patients were randomly assigned to one of three groups, group C (no prophylactic antiemetics), groups N (ramosetron ODT 30 minutes before the induction), and group Z (intravenous injection of ondansetron 4 mg at the end of surgery followed by continuous infusion of 8 mg added to the PCA solution). A standard general inhalation anesthesia and IV PCA with fentanyl and ketorolac were used. During the 48 hours after recovery, we assessed pain score by: using a visual analogue scale (VAS), a sedation scale, an incidence of PONV, and monitoring consumption of PCA drug, rescue drug consumption, adverse events, and overall satisfaction. RESULTS: The incidence of nausea and the consumption of rescue drug were significantly decreased in N and Z groups at each time point except 24-48 hours after recovery. There was no significant difference in incidence of vomiting. Overall satisfaction was superior in N and Z groups compared with C group. CONCLUSIONS: Preoperative administration of ramosetron ODT was an acceptable and effective way to prevent PONV in patients using PCA.