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Background: In laparoscopic surgeries, insufflation with carbon dioxide triggers vagal afferents on the bowel and peritoneum which induces emesis by activating the vomiting center. It is hypothesized that combined antiemetics with different sites of activity would be more effective than one drug alone for the prophylaxis against PONV. So, the present study was planned to compare the efficacy of granisetron, dexamethasone and combination of granisetron with dexamethasone to prevent PONV.Methods: This randomized prospective double-blind study was performed on 120 patients, aged between 18 and 58 years of ASA physical status I and II of either sex undergoing laparoscopic surgeries under general anesthesia. Patients were randomized in three groups, group I (granisetrone 2 mg I.V.), group II (dexamethasone) 8 mg I.V., group III (granisetrone+dexamethasone) 2 mg+8 mg I.V. with 40 patients in each group. Complete response, incidence of nausea, vomiting, and rescue antiemetic were recorded at specified intervals.Results: A complete response (defined as no PONV and no need for another rescue antiemetic) was achieved in 75% of the patients given granisetron, 70% in dexamethasone and in 92.5% of the patients given granisetron plus dexamethasone (P <0.05). The overall cumulative incidences (0-24 hours) of PONV were 10 (25%) in the granisetron, 12 (30%) in the dexamethasone and 3 (7.5%) in the combination group. No difference in adverse events were observed in any of the groups.Conclusions: The prophylactic therapy of granisetron 2 mg plus dexamethasone 8 mg just before induction of anaesthesia is significantly effective in prevention of PONV in patients undergoing laparoscopic surgeries.
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Background: The improved understanding of origin of abdominal and shoulder pain after laparoscopic procedures led to the use of intra peritoneal and port site instillation of local anaesthetic to reduce post-operative pain. Combinations of intraperitoneal local anaesthetics with many opioids have been studied in past and it was proved that they provide additional analgesic benefits. Material and methods: 106 ASA grade I and II patients of age 20 to 60 years of either sex weighing 40 to 70 kg undergoing laparascopic cholecystectomy under general anaesthesia were enrolled for the present study after written informed consent and institutional ethical committee cleareance. Patients were randomized into two groups , Group I (n=53): Patients received 30ml of 0.5% ropivacaine with 2ml Normal Saline. Group II (n=53): Patients received 30ml of 0.5% ropivacaine with fentanyl 100 mcg (2 ml). General anaesthesia was standardized. VAS, VRS scores, hemodynamics, total amount of rescue analgesic and side effects were noted at regular intervals. Results: VAS and VRS score were significantly lower in ropivacaine plus fentanyl group in comparisons to ropivacaine alone group at most of the time intervals. Hemodynamics was comparable between the two groups. Total Rescue analgesic were also significantly ow in ropivacaine plus fentanyl group side effects were comparable between two group. Conclusion: Intraperitoneal instillation of ropivacaine with fentanyl reduces not only the intensity of visceral, parietal and shoulder pain but also the total rescue analgesic dose consumption.
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Only 2% of carcinoids originate from the thymus with an estimated incidence of 1.5 to 3 per 10,000,000 persons per year. We present the case of a 30-year-old female patient in whom the diagnosis was confirmed by a fine needle aspiration cytology of a large mediastinal mass.