Palonosetron for postoperative nausea and vomiting after gynecological laparoscopic surgery: Comparison of its effect on sevoflurane vs desflurane vs total intravenous anesthesia

BACKGROUND: Postoperative nausea and vomiting (PONV) is one of the most common complications after gynecological laparoscopic surgery and it appears more frequently after use of inhalation anesthetics than total intravenous anesthesia (TIVA). Palonosetron was introduced as a new-generation potent antiemetic agent, which may reduce PONV more effectively than previous drugs. The aim of this study was to evaluate whether palonosetron could prevent PONV after gynecological laparoscopic surgery, regardless of the anesthetic technique employed. METHODS: Seventy-three patients scheduled for gynecological laparoscopic surgery were randomly assigned into 3 groups according to the anesthetic agent employed (group 1: inhalation anesthesia with desflurane, group 2: inhalation anesthesia with sevoflurane, group 3: total intravenous anesthesia with propofol and remifentanil). Palonosetron 0.075 mg was administered intravenously before the induction. Opioids were not used for postoperative pain control. The incidences of nausea, vomiting and side effects were recorded from 2 hr upto 48 hr, postoperatively. RESULTS: There were no significant differences in the incidence of PONV, severity of nausea, and the use of rescue antiemetics among the groups, throughout the observation. No differences were observed in the adverse side effects among the groups. CONCLUSIONS: Palonosetron decreased the incidence of PONV after gynecological laparoscopic surgery to a similar level, regardless of the anesthetic technique.

Effects of lidocaine, ketamine, and remifentanil on withdrawal response of rocuronium / 대한마취과학회지

BACKGROUND: Rocuronium has been well known to produce withdrawal response in 50-80% patients when administered intravenously. Several drugs are administered prior injection of rocuronium to prevent the withdrawal response. We compared the preventive effect of lidocaine, ketamine, and remifentanil on the withdrawal response of rocuronium. METHODS: A total of 120 patients undergoing various elective surgeries were enrolled. Patients were allocated into 4 groups according to the pretreatment drugs (Group N, normal saline; Groups L, lidocaine 40 mg; Group K, ketamine 0.5 mg/kg; Group R, remifentanil 1 microg/kg). Patients received drugs prepared by dilution to 3 ml volume before injection of rocuronium. Withdrawal responses after injection of rocuronium were graded on a 4-point scale. Hemodynamic changes were observed before and after administration of pretreatment drugs and after endotracheal intubation. RESULTS: Incidence of withdrawal response was significantly lower in group L (20%), group K (30%), and group R (0%), than group N (87%). Severe withdrawal response was observed in 5 of the 30 patients (17%) in group L, and in 9 of the 30 patients (30%) in group K. There was no severe withdrawal response in group R. Mean blood pressure and heart rate were significantly decreased in group R compared to other groups. CONCLUSIONS: It seems that remifentanil (1 microg/kg intravenously) was the strongest and most effective in prevention of withdrawal response after rocuronium injection among the 3 drugs.