Effect of Adding Midazolam to Dual Prophylaxis for Preventing Postoperative Nausea and Vomiting.

Jiyoung Lee,Jong Yeop Kim,In Kyong Yi,Chunghyun Park,Jung Youn Han,Eun Duc Na

doi:10.3390/jcm10214857

Abstract

Multimodal prophylaxis for postoperative nausea and vomiting (PONV) has been recommended, even in low-risk patients. Midazolam is known to have antiemetic properties. We researched the effects of adding midazolam to the dual prophylaxis of ondansetron and dexamethasone on PONV after gynecologic laparoscopy. In this prospective, randomized, double-blinded trial, 144 patients undergoing gynecological laparoscopic surgery under sevoflurane anesthesia were randomized to receive either normal saline (control group, n = 72) or midazolam 0.05 mg/kg (midazolam group, n = 72) intravenously at pre-induction. All patients were administered dexamethasone 4 mg at induction and ondansetron 4 mg at the completion of the laparoscopy, intravenously. The primary outcome was the incidence of complete response, which implied the absence of PONV without rescue antiemetic requirement until 24 h post-surgery. The complete response during the 24 h following laparoscopy was similar between the two groups: 41 patients (59%) in the control group and 48 patients (72%) in the midazolam group (p = 0.11). The incidence of nausea, severe nausea, retching/vomiting, and administration of rescue antiemetic was comparable between the two groups. The addition of 0.05 mg/kg midazolam at pre-induction to the dual prophylaxis had no additive preventive effect on PONV after gynecologic laparoscopy.

Highlights

Since the etiology of Postoperative nausea and vomiting (PONV) is multifactorial and the mechanism is complex, multimodal prophylaxis has been recommended in high-risk patients [4]
The key concept of multimodal prophylaxis is that a combination of antiemetics of different classes acts on different receptors
The primary outcome was the incidence of complete response, defined in this study as the absence of PONV without requiring rescue antiemetics until 24 h after operation

Summary

Introduction

Postoperative nausea and vomiting (PONV) are common and severe complications following an operation and are often associated with delayed recovery and extended length of hospital stay [1]. Gynecologic laparoscopy, in particular, is correlated with a relatively higher incidence of PONV (approximately 80%) if no prophylactic antiemetics are administered [2]. The recognized risk factors for PONV are female sex, use of postoperative opioids including patient-controlled analgesia (PCA), volatile anesthesia, gynecologic surgery, and increased intra-abdominal pressure during laparoscopy [3]. Since the etiology of PONV is multifactorial and the mechanism is complex, multimodal prophylaxis has been recommended in high-risk patients [4]. The key concept of multimodal prophylaxis is that a combination of antiemetics of different classes acts on different receptors.

Methods

Results

Discussion

Conclusion