Comparison of palonosetron and ondansetron in preventing postoperative nausea and vomiting in renal transplantation recipients: a randomized clinical trial

Abstract Background: End-stage renal diseases patients have a high risk of postoperative nausea and vomiting (PONV), which is multifactorial and need acute attention after renal transplantation for a successful outcome in term of an uneventful postoperative period. The study was done to compare the efficacy of palonosetron and ondansetron in preventing early and late-onset PONV in live donor renal transplantation recipients (LDRT). Methods: The prospective randomized double-blinded study was done on 112 consecutive patients planned for live donor renal transplantation. Patients of both sexes in the age group of 18-60 years were randomly divided into two groups: Group O (Ondansetron) and Group P (Palonosetron) with 56 patients in each group by computer-generated randomization. The study drug was administered intravenously (IV) slowly over 30 seconds, one hour before extubation. Postoperatively, the patients were accessed for PONV at 6, 24, and 72 hours using the Visual Analogue Scale (VAS) nausea score and PONV intensity scale. Results: The incidence of PONV in the study was found to be 30.35%. There was significant difference in incidence of PONV between Group P and Group O at 6 hours (12.5% vs. 32.1%, p = 0.013) and 72 hours (1.8% vs. 33.9%, p < 0.001), but insignificant difference at 24 hours (1.8% vs. 10.7%, p = 0.113). VAS-nausea score was significantly lower in Group P as compared to Group O at a time point of 24 hours (45.54 ± 12.64 vs. 51.96 ± 14.70, p = 0.015) and 72 hours (39.11 ± 10.32 vs. 45.7 ± 15.12, p = 0.015). Conclusion: Palonosetron is clinically superior to ondansetron in preventing early and delayed onset postoperative nausea and vomiting in live-related renal transplant recipients.

The curative effect observation of different frequency of TEAS combined with wristband pressing on Neiguan (PC 6) for nausea and vomiting after laparoscopic cholecystectomy / 中国针灸

OBJECTIVE@#To compare the effects of different frequency of transcutaneous electrical acupoint stimulation (TEAS) combined with wristband pressing on Neiguan (PC 6) for nausea and vomiting (PONV) after laparoscopic cholecystectomy, and optimize the TEAS frequency selection for treatment of PONV.@*METHODS@#Eighty patients undergoing laparoscopic cholecystectomy were randomly divided into a postoperative routine care group, a 2 Hz TEAS combined with wristband pressing group (2 Hz TEAS group), a 100 Hz TEAS combined with combined with wristband pressing group (100 Hz TEAS group) and a 2 Hz/100 Hz TEAS wristband pressing group (2 Hz/100 Hz TEAS group), 20 cases in each group (1 patient dropped off in the postoperative routine care group). All the four groups underwent laparoscopic cholecystectomy, and routine nursing was given after the operation. In the postoperative routine nursing group，only routine nursing was received. In the other three groups, 2 Hz TEAS combined with wristband pressing, 100 Hz TEAS combined with wristband pressing, 2 Hz/100 Hz TEAS combined with wristband pressing to simulate Neiguan (PC 6) were treated on the basis of postoperative routine care after surgery. The treatment was given for 30 min each time for a total of 4 treatments. The incidence of PONV in each group was observed at 0-2 h, 2-8 h, 8-24 h and 24-48 h after operation, and the severity of PONV and postoperative pain were evaluated.@*RESULTS@#Compared with the postoperative routine care group, the incidence and severity of PONV in the four time periods after surgery were significantly reduced in the 2 Hz/100 Hz TEAS group (all <0.05), the incidence and severity of PONV in patients at 2 h and 2-8 h after surgery were significantly reduced in the 2Hz TEAS group and the 100 Hz TEAS group (all <0.05), the postoperative pain at 8 h and 24 h after surgery was alleviated in the 100 Hz TEAS group and the 2 Hz/100 Hz TEAS group (all <0.05).@*CONCLUSION@#Different frequency of TEAS combined with wristband pressing to stimulating Neiguan (PC 6) have certain therapeutic effects on PONV in patients undergoing laparoscopic cholecystectomy. 2 Hz/100 Hz TEAS combined with wristband pressing at Neiguan (PC 6) is more effective in PONV. 2 Hz/100 Hz TEAS and 100 Hz TEAS combined with wristband pressing at Neiguan (PC 6) have postoperative analgesic effect, and 2 Hz/100 Hz TEAS has the better analgesic effect.

Analysis of Credibility and Validity of Chinese Medical Constitution Questionnaire in Risk Evaluation of Postoperative Nausea and Vomiting Patients / 广州中医药大学学报

Objective To preliminarily analyze the credibility and validity of Chinese Medical Constitution Questionnaire(CMCQ).Methods CMCQ was used to investigate the distribution of Chinese medical constitution types of 450 women inpatients with postoperative nausea and vomiting (PONV) after gynecologic laparoscopic surgery from March to October of 2013.Credibility and validity were analyzed by Cronbach's α coefficient and factor analysis.Results Mixed constitution was identified in 184 (40.9％) patients.Cronbach's α coefficient of two dimensions (yang deficiency and qi stagnation) of CMCQ was proper,being 0.815 and 0.803 respectirely,while that of the dimension of harmony type was the lowest (0.514).The total variance explained by 9 common factors extracted from the results of factor analysis was only 48.5％.Conclusion CMCQ may need further revision based on the results of clinical application.

Comparison of palonosetron with ondansetron in preventing postoperative nausea and vomiting after thyroidectomy during a 48-hour period

BACKGROUND: Postoperative nausea and vomiting (PONV) are common complications after general anesthesia. This study compared the effects of palonosetron and ondansetron in preventing PONV in patients undergoing thyroidectomy. METHODS: 100 non-smoking female subjects were randomly assigned to a palonosetron group (n = 50) or an ondansetron group (n = 50). The patients of each group received 0.075 mg of palonosetron or 8 mg of ondansetron through intravenous bolus injection before induction of general anesthesia. The incidence of nausea and vomiting were monitored at 2 h, 24 h and 48 h after operation. RESULTS: The incidence of PONV during 48 h after operation had no significant differences between the groups. However, the incidence of nausea was lower in the palonosetron group than in the ondansetron group (34% vs. 56%, P = 0.027). No differences were observed in incidences of vomiting, use of antiemetics and adverse events between the groups. CONCLUSIONS: Palonosetron was more effective than ondansetron in preventing nausea for patients undergoing thyroidectomy. However, the effect of palonosetron or ondansetron in preventing PONV was similar.

How much are patients willing to pay for prevention of postoperative nausea and vomiting? / 대한마취과학회지

BACKGROUND: Postoperative nausea and vomiting (PONV) remains a common complication of anesthesia. We tried to assess the amount patients were willing to pay for a hypothetical antiemetic that would completely prevent PONV. METHODS: Trained residents interviewed 86 patients, who were scheduled to undergo general anesthesia, and questionnaires were completed. RESULTS: Patients were willing to pay a median of 30,000 won for an antiemetic that would completely prevent PONV. The amounts patients were willing to pay correlated with age, previous history of PONV, and patient income. CONCLUSIONS: Patients assigned a value for avoidance of PONV. It is suggested that more efforts to prevent PONV would be helpful for the increase in patient satisfaction.

The effects of prophylactic dolasetron and induction with propofol on postoperative nausea and vomiting after thyroidectomy / 대한마취과학회지

BACKGROUND: Postoperative nausea and vomiting (PONV) is a common problem in patients undergoing thyroidectomy. In this study we evaluated the effects of prophylactic dolasetron and/or induction with propofol on PONV. METHODS: Two hundred three patients scheduled thyroidectomy under general anesthesia with sevoflurane were included and were randomly allocated to one of four groups. In control (group C) and dolasetron groups (group D), the patients received thiopental sodium 4-5 mg/kg intravenously for the induction of anesthesia, and the patients in group D received prophylactic intravenous dolasetron 210 microgram/kg. In propofol (group P) and dolasetron + propofol groups (group D + P), the patients received propofol 2 mg/kg intravenously for the induction of anesthesia, and the patients in group D + P received prophylactic intravenous dolasetron 210 microgram/kg. The incidence and severity of PONV, the need for rescue antiemetics, adverse events were assessed during 0 to 1 hour and 1 to 24 hours postoperatively. RESULTS: During the first 24 hours after anesthesia, the incidences of PONV and postoperative vomiting were significantly reduced in group D + P compared with group C (P < 0.05, respectively). There were no significant differences in postoperative nausea, need for rescue antiemetics, severity of PONV, and adverse events of antiemetics among the four groups. CONCLUSIONS: In patients with thyroidectomy, combination of prophylactic dolasetron administration and induction with propofol was found to reduce the incidence of PONV during the first 24 hours after anesthesia, compared with that of routine induction with thiopental sodium.

The Optimal Anti-emetic Dose of Ramosetron for Prevention of Postoperative Nausea and Vomiting Following Gynecolgic Surgery / 대한마취과학회지

BACKGROUND: Postoperative nausea and vomiting (PONV) is one of the most frequent and distressing side effects of surgery, and approximately 50-70% of patients who undergo gynecologic surgery suffer from PONV. In this study, we evaluated the effects of various doses of ramosetron on postoperative nausea and vomiting following gynecologic surgery. METHODS: This study evaluated a randomized placebo-controlled study comprised of 200 patients who underwent gynecologic surgery under general anesthesia. The patients were divided into the following 4 groups; placebo group (saline 4 ml), R15 group (ramosetron 0.15 mg), R30 group (ramosetron 0.3 mg) and R45 group (ramosetron 0.45 mg). Each patient was administered the study drug intravenously at the completion of the operation and the presence and severity of PONV were then evaluated 24 and 48 hours after the operation. RESULTS: The incidence of PONV during the first 24 hours following surgery was lower in patients in the R30 group (44%) than in patients in the placebo group (68%)(P < 0.05). In addition, the incidence of PONV 24 to 48 hours after the operation was lower in patients in the R30 group (12%) and the R45 group (14%) than in patients in the placebo group (44%)(P < 0.05) Moreover, common side effects of 5-HT3 receptor antagonist such as headache, dizziness, and constipation did not develop in any of the groups. CONCLUSIONS: The results of this study indicate that 0.3 mg of ramosetron is the most effective dose for preventing PONV during to the first 48 hours following gynecologic surgery.

Comparison between Bolus Injection and Continuous Infusion of Ondansetron on Nausea and Vomiting in Intravenous, Patient-controlled Analgesia after Laparoscopic-assisted Vaginal Hysterectomy using Propofol and Remifentanil Anesthesia / 대한마취과학회지

BACKGROUND: The aim of this study was to evaluate the effect of continuous infusion of ondansetron compared with bolus injection on the incidence of postoperative nausea and vomiting (PONV) in intravenous, patient-controlled analgesia (PCA). METHODS: Sixty three women undergoing laparoscopic-assisted vaginal hysterectomy were randomly allocated according to the method of ondansetron administration: bolus injection of ondansetron (8 mg) after the operation (Bolus group, n = 21); continuous infusion after ondansetron (8 mg) mixed to PCA (PCA 8 mix group, n = 22); and continuous infusion after ondansetron (16 mg) mixed to PCA (PCA 16 mix group, n = 20). The PONV were measured at 1 hr, 6 hr, 24 hr and 48 hr after operation and pain scores (visual analog scale, VAS) were checked. RESULTS: The incidence of PONV during 48 hr in the Bolus group (23.8%) and PCA 16 mix group (20.0%) were significantly lower than PCA 8 mix group (54.5%) (P < 0.05). The three groups showed similar VAS pain scores. CONCLUSIONS: Our results suggest that continuous infusion of ondansetron 16 mg is as effective as a bolus injection of ondansetron (8 mg) at preventing PONV in high-risk patients.

Effectiveness of Ondansetron and Midazolam in the Prevention of PONV after Thyroidectomy / 대한마취과학회지

BACKGROUND: The purpose of this study was to investigate the effectiveness of ondansetron and midazolam in the prevention of PONV after thyroidectomy. METHODS: One hundred nineteen women undergoing thyroidectomy under general anesthesia were randomized to receive midazolam 0.075 mg/kg (Group M, n = 41), ondansetron 4 mg (Group O, n = 39), or normal saline 10 ml (Group C, n = 39) intravenously. The incidence and severity of nausea, vomiting, and pain were assessed as 6 and 24 h after the end of surgery. RESULTS: The incidence of PONV was 34% in Group M, 46% in Group O, and 64% in Group C, which showed a significant difference between Group C and Group M, but not Group O. However, there were no significant differences between groups in pain scores and the incidence of sedation. CONCLUSIONS: We recommend the use of midazolam as an effective antiemetic after thyroidectomy.

The Effects of Supplemental Oxygen on Postoperative Nausea and Vomiting, Pain, and Stress Hormones / 대한마취과학회지

BACKGROUND: Supplemental oxygen has been reported to diminish postoperative nausea and vomiting (PONV). Surgical trauma causes increased response of stress hormones. Therefore, we aimed to investigate whether supplemental oxygen attenuates release of adrenocorticotrophic hormone (ACTH) and cortisol as well as PONV in patients undergoing thyroidectomy. METHODS: One hundred female patients were randomly assigned to two groups: 30% oxygen (Group 30) and 80% oxygen (Group 80). The incidence and the severity of PONV and pain score were evaluated 2, 6, 24 h postoperatively. PaO2, ACTH and cortisol were measured in 40 patients before tracheal intubation under 100% oxygen and at the end of surgery under designated oxygen concentration. RESULTS: The PaO2 at induction was similar between the groups, but significantly higher in the group 80 than group 30 at the end of surgery. There were no differences in the incidence and the severity of PONV and pain score postoperatively between the groups. ACTH increased significantly at the end of surgery in both groups, but cortisol did not. There were no differences in ACTH and cortisol between the groups. CONCLUSIONS: Supplemental oxygen during thyroidectomy did not reduce the incidence and severity of PONV, postoperative pain, and stress hormone responses.

Effect of Midazolam upon the Prevention of Nausea and Vomiting after Middle Ear Surgery / 대한마취과학회지

BACKGROUND: Midazolam has been reported to decrease postoperative nausea and vomiting (PONV). We studied the antiemetic effect of midazolam after middle ear surgery. METHODS: In this prospective, randomized, double-blind, placebo-controlled study, 90 healthy patients were scheduled for middle ear surgery (tympanomastoidectomy and tympanoplasty). Patients were randomly divided into two groups; Midazolam 0.075 mg/kg (n = 45) or normal saline (n = 45) was administered after induction of anesthesia. The incidence of PONV, metoclopramide and ketorolac usage, pain, sedation, and other side effects were assessed at 6, 24 h after the operation. RESULTS: The incidences of PONV were 15 (33%) in midazolam group and 27 (60%) in placebo group during 24 h postoperatively. The incidence of PONV in midazolam group was significantly lower than that in placebo group (P < 0.05). There were no significant differences between groups in adverse events. CONCLUSIONS: Midazolam 0.075 mg/kg was effective for preventing PONV after middle ear surgery without significant adverse effects.

Low Pressure (8 mmHg) Pneumoperitoneum does not Reduce the Incidence and Severity of Postoperative Nausea and Vomiting (PONV) following Gynecologic Laparoscopy / 대한마취과학회지

BACKGROUND: Postoperative nausea and vomiting (PONV) is distressing complication of anesthesia and surgery, with a relatively high incidence in women undergoing gynecologic laparoscopy. Therefore, this study aimed to investigate occurrence and severity of PONV of low pressure (LP [8 mmHg]) in comparison to standard pressure (SP [13 mmHg]) pneumoperitoneum. METHODS: 46 consecutive patients qualified for elective gynecologic laparoscopy were randomly allocated to either SP group (n = 23) or LP group (n = 23). All the patients were separately evaluated at three intervals of 0-2 h, 2-6 h and 6-24 h during the first postoperative 24 hours with regard to emetic symptoms. Additionally, the degree of surgical exposure in LP group was rated in 4-point scale by surgeon. RESULTS: The overall incidence of PONV during the initial 24 postoperative hours did not differ between the groups (65.2% in LP group vs 82.6% in SP group, P = 0.314). There was also no difference between the groups in regard to the incidence and severity of PONV and postoperative nausea, consumption of analgesics and the need for rescue ondansetron at any separate observation periods. However, some degrees of surgical difficulties were rated in 12 patients (52.1%) from LP group. Furthermore, mean estimated blood loss in LP group was significantly increased than in SP group (P < 0.05). CONCLUSIONS: We conclude that lowering of the insufflation pressure to 8 mmHg can not reduce the incidence and severity of PONV after gynecologic laparoscopy and even increase the noticeable surgical difficulties and risks in some cases.

Antiemetic Effect of Midazolam added to Patient-Controlled Analgesia after Total Abdominal Hysterectomy / 대한마취과학회지

BACKGROUND: Midazolam has been reported to decrease postoperative nausea and vomiting (PONV). We studied the antiemetic effect of midazolam in patients receiving intravenous patient-controlled analgesia (PCA) using morphine after total abdominal hysterectomy. METHODS: Group C (n = 27) received bolus of morphine 5 mg and PCA of morphine 1 mg/ml. Group M1 (n = 27) received bolus of morphine 5 mg and midazolam 1 mg and PCA of midazolam 0.2 mg/ml mixed with morphine 1 mg/ml. Group M2 (n = 27) received bolus of morphine 5 mg and midazolam 1 mg and PCA of midazolam 0.4 mg/ml mixed with morphine 1 mg/ml. The PCA delivery system was programmed to deliver 1 ml of the test solution per demand with a 10 min lockout interval and no background infusion. The incidence of PONV, metoclopramide and ketorolac usage, morphine and midazolam consumption, pain, sedation, and other side effects were assessed at 1, 4, 8, 16, 24, 36 and 48 h after the operation. RESULTS: The incidences of PONV were 19 (70%) in Group C, 14 (52%) in Group M1 and 10 (37%) in Group M2. The incidence of PONV in Group M2 was significantly lower than that in Group C (P < 0.05). Patients in Group M2 experienced more sedation than those in Group C (P < 0.05). No severe sedation was observed in all groups. CONCLUSIONS: Combination of midazolam 0.4 mg per morphine 1 mg in PCA had more effective antiemetic efficacy than control without significant adverse effects.

The Effects of Prophylactic Metoclopramide and Induction with Propofol on Postoperative Nausea and Vomiting / 대한마취과학회지

BACKGROUND: Postoperative nausea and vomiting (PONV) are common problems in patients undergoing a laparoscopic cholecystectomy. This study evaluated the effect of prophylactic metoclopramide (MCP) and induction with propofol on PONV. METHODS: 165 patients undergoing laparoscopic cholecystectomy were randomly divided into four groups. Groups 1 (control group) and 2 were inducted with thiopental sodium. Groups 3 (propofol group) and 4 were inducted with propofol. Prophylactic metoclopramide 10 mg i.v. was administered in Groups 2 (MCP group) and 4 (propofol + MCP group). The incidence of PONV, the need for rescue antiemetics, adverse events, and the nausea severity scores were assessed at 0 to 1 hour and at 1 to 24 hours postoperatively. RESULTS: During the first 24 hours after anesthesia, the incidence of PONV in Groups 1, 2, 3 and 4 was 41.5%, 29.3%, 30.3% and 23.3%, respectively. There was no significant difference between the groups. During the period, 1 hour to 24 hours, after anesthesia, the incidence of PONV in Groups 1, 2, 3 and 4 was 36.6%, 17.4%, 27.5% and 14.4%, respectively. The incidence of PONV in Group 4 was significantly lower than in Group 1 (P < 0.05). CONCLUSIONS: In patients with laparoscopic cholecystectomy, a combination of prophylactic metoclopramide administration and induction with propofol was found to reduce the incidence of PONV by about 22.6% during the period 1 hour to 24 hours after anesthesia.

Effects of Prophylactic Antiemetic Combination of Dexamethasone and Ondansetron on Postoperative Nausea and Vomiting in High-risk Patients / 대한마취과학회지

BACKGROUND: In the previous study, patients at high risk for postoperative nausea and vomiting (PONV) were identified by the Korean risk model. Consecutively, we investigated whether high-risk patients based on the Korean risk model could be managed with multiple prophylactic antiemetics. METHODS: Patients scheduled for elective surgery under general anesthesia were classified in two risk groups (first group: high risk group, second group: very high risk group) by using the Korean risk model. All patients received volatile general anesthesia and antiemetic combination of dexamethasone 5 mg (after induction) and ondansetron 4 mg (before end of surgery). We investigated the incidences of PONV in the postanesthetic care unit and at ward. RESULTS: Compared with the data from our previous study, the overall incidence of PONV decreased from 52.2% to 23.1% (P< or =0.001). The incidence decreased from 47.4% to 19.4% (P< or =0.001) in the high risk group and from 61.6% to 32.2% (P< or =0.001) in the very high risk group. The relative risk reduction did not differ between two groups (59.1%:47.7%). CONCLUSIONS: Antiemetic prophylactic with combination of dexamethasone and ondansetron was equally effective in reducing the occurrence of PONV in both group patients.

The Preventive Effect on Postoperative Nausea and Vomiting According to Dosages of Intraoperative Intravenous Ondansetron in Cesarean Section Patients under Patient-Controlled Epidural Analgesia / 대한마취과학회지

BACKGROUND: Ondansetron is a specific 5-hydroxytrypamine (HT3) receptor antagonist, sodium channel blocker and mu-opioid receptor agonist. Prophylactic intravenous administration of ondansetron has an antiemetic effect in general and epidural anesthesia. This study is designed to evaluate the antiemetic effect of intravenous ondansetron in patient-controlled epidural analgesia (PCEA) patients. METHODS: Sixty ASA physical status I-II patients undergoing elective cesarean section under epidural anesthesia using 0.75% ropivacaine and fentanyl 50microgram were received intravenous fentanyl 50microgram plus ondansetron 2 mg (group 2 mg: n = 20), 4 mg (group 4 mg: n = 20) or 8 mg (group 8 mg: n = 20) after delivery of baby. PCEA was started using 0.15% ropivacaine and 50microgram/ml butorphanol (total volume: 300 ml, 4 ml of bolus dose, and 10 min of lockout interval). The intraoperative and postoperative incidence and severity of nausea and vomiting were recorded using 4 point scale (0: none, 1: mild, 2: moderate, 3: severe) for postoperative 24 hours. RESULTS: There were no significantly lower incidence and severity of nausea and vomiting in group 8 mg (10%, 5%) than group 2 mg (25%, 10%), and group 4 mg (20%, 10%) during postoperative 24 hours. CONCLUSIONS: Prophylactic intravenous ondansetron 8 mg injection with PCEA drug has no superior antiemitic effect than 2 mg or 4 mg in cesarean section patients under PCEA without significant side effects.

The Effect of Continuous Infusion of Ondansetron on Nausea and Vomiting during Intravenous Patient-controlled Analgesia / 대한마취과학회지

BACKGROUND: This study was designed to determine the effectiveness of the continuous infusion of ondansetron for the prevention of postoperative nausea and vomiting (PONV) in intravenous patient-controlled analgesia (PCA). METHODS: One hundred and sixty patients undergoing spinal surgery were randomized into four groups according to the method of ondansetron administration, placebo (n = 40, group 1), ondansetron 8 mg mixed to IV PCA (n = 40, group 2), ondansetron 4 mg IV before induction or after surgery in addition to 8 mg mixed to IV PCA (n = 40, group 3 or n = 40, group 4). The incidences of nausea, vomiting, and side effects were recorded for 48 hr postoperatively. RESULTS: The incidence of nausea in group 1 (43 %) was significantly higher than in the other groups (group 2; 18%, group 3; 15%, group 4; 18%) (P < 0.05), and vomiting was one in group 1. CONCLUSIONS: Continuous ondansetron infusion is effective at preventing PONV, but the effects of additional bolus injections to continuous infusion of ondansetron were not different from continuous infusion only.

Comparison of Postoperative Nausea and Vomiting between Gynecologic Surgery and Cesarean-Section during Intravenous Patient-Controlled Analgesia with Fentanyl / 대한마취과학회지

BACKGROUND: The purpose of this study was to compare the incidence of postoperative nausea and vomiting (PONV) in patients undergoing major gynecologic surgery with those undergoing Cesarean-section during intravenous patient-controlled analgesia (PCA). METHODS: Seventy two patients received general anesthesia with enflurane. Group 1 patients underwent major gynecologic surgery, and group 2 patients were parturients who underwent Cesarean-section. Postoperatively, fentanyl was continuously infused i.v. using Accufuser PLUS (basal, 2 ml/h; bolus, 0.5 ml; lockout interval, 15 min) containing fentanyl 25microgram/kg in saline. PONV was evaluated at 6, 12, 24 and 36 h after starting continuous infusion and compared in the two groups. RESULTS: The incidence of PONV was significantly lower in group 2 (14%) than in group 1 (67%) (P < 5). CONCLUSIONS: Our results show that the incidence of PONV was lower for Cesarean-section than for gynecologic surgery.

Effect of Low Dose Dexamethasone upon the Prevention of Postoperative Nausea and Vomiting after Thyroidectomy / 대한마취과학회지

BACKGROUND: Postoperative nausea and vomiting (PONV) are common and unpleasant experiences. Several studies have demonstrated that dexamethasone has a potent antiemetic effect for the prophylaxis of PONV, and that dexamethasone is beneficial in the management of acute surgical pain because of its potent anti-inflammatory effect. In this randomized study, we evaluated the effect of dexamethasone 5 mg on PONV and pain in 73 patients after thyroidectomy. METHODS: Dexamethasone 5 mg or saline 2 ml was IV administered in a randomized manner immediately after the induction of anesthesia in each group. Patients were assessed for the incidence of PONV at 6 h and 24 h after surgery, rescue antiemetics, total amount of analgesic, time to first analgesic demand, and VAS pain score at 6 h after surgery. The occurrence of side effects, such as, wound infection or delayed wound healing, and the duration of hospital stay were recorded. RESULTS: The incidence (21.1%, 8/38) of PONV in the dexamethasone group was significantly lower than (71.4%, 25/35) in the saline group during the 6 h postoperative period (P<0.05). PONV occurred in 7.9% of patients in the dexamethasone group and in 51.4% of patients in the saline group during the 6-24 h postoperative period. The proportion (7.9%) of patients requiring antiemetics was significantly lower in the dexamethasone group than in the saline group (25.7%) at 24 h postoperatively. The incidence of analgesic use, the total amount of analgesic and the VAS pain score were not significantly different in the two groups. No discernible side effects were found. CONCLUSIONS: Dexamethasone 5 mg was effective at preventing PONV after thyroidectomy, but it had no effect on postoperative pain.

Prophylactic Antiemetic Efficacy of Ondansetron in Gynecologic Pelviscopic Patients / 대한마취과학회지

BACKGROUND: The safety and efficacy of ondansetron were evaluated for the prophylaxis of postoperative nausea and vomiting (PONV) after pelviscopic gynecologic procedure. We compared the effects of three doses of intravenous ondansetron, 1 mg, 4 mg, and 8 mg. METHODS: Eighty women were randomly allocated to one of 4 groups receiving 1 mg (group 1, n = 20), 4 mg (group 2, n = 20), 8 mg (group 3, n = 20) or normal saline (group 4, n = 20) at the end of pelviscopic operation. PONV were measured using a 4 point scale (0: none, 1: mild, 2: moderate, 3: severe) 1 hr, 2 hr, 6 hr, 12 hr, 24 hr after the operation and other side effects were checked. RESULTS: Over the 24 hr study period, group 2 and 3 showed a significant lower incidence of nausea (15%, 10%) and vomiting (5%, 5%) than in group 1 (nausea: 25%, vomiting: 5%) or group 4 (nausea: 40%, vomiting: 30%). Complete response rates of each group were 80%, 90%, 90% and 50% during first 2 hrs and 50%, 80%, 75% and 30% after 2 hrs after operation. Adverse events were minor, and ondansetron treated patients had profiles similar to those of the placebo. CONCLUSIONS: We concluded that ondansetron at 4 mg or 8 mg is a safe and effective prophylactic antiemetic for women requiring gynecologic pelviscopic surgery under general anesthesia.