The Addition of Midazolam Reduces the Incidence of Early Postoperative Nausea and Vomiting in Short Time Gynecological Procedures

Vsevolod Rozentsveig,Moti Klein,Alexander Zlotnik,Mathew Boyko,Leonid Koyfman,Evgeni Brotfain

doi:10.4236/ojanes.2015.51003

Abstract

Background: If untreated, one third of patients who undergo surgery develop postoperative nausea and/or vomiting (PONV). The prevention of postoperative nausea and vomiting can improve satisfaction among vulnerable patients. We hypothesized that preoperative anxiety may increase the incidence of PONV. The objective was to assess whether administration of a benzodiazepine prior to surgery would reduce the incidence of PONV. Methods: 130 women (ASA I and II) scheduled to undergo dilatation and curettage comprised the study group. The women were allocated randomly to two study groups according to the type of anesthesia administered (with and without midazolam). Results: Sixty-eight women received midazolam and 62 did not. Patients treated with midazolam were feeling more comfortable (“friendliness”, p = 0.005 and “elation”, p = 0.01) and had less postoperative fatigue (p = 0.04) than non-midazolam-treated group. Patients treated with midazolam had significantly fewer emetic episodes during the first 4 hours after surgery than those without midazolam (0.1 ± 0.2 vs 0.3 ± 0.6, respectively, p = 0.003). Conclusions: Midazolam reduces the incidence of PONV and improves patient’s comfort. We suggest that midazolam has to be routinely included in the anesthesia protocol for short-term gynecological procedures (dilatation and curettage).

Highlights

Postoperative nausea and vomiting (PONV) are commonly seen after surgical procedures that require general anesthesia
The patients’ pre-operative anxiety state was assessed by the Profile of Mood Stated (POMS) [8], which was completed for each patient 30 minutes before they entered the operating room by an anesthesia resident who had been previously trained in the appropriate interview technique
Sixty-eight (68) patients were randomized in study Group 1

Summary

Introduction

Postoperative nausea and vomiting (PONV) are commonly seen after surgical procedures that require general anesthesia. Since anesthesia is administered to more than 75 million surgical patients annually worldwide [2] and since the incidence of vomiting during the first postoperative day is as high as 25% - 40% [3], the enormous economic cost of this complication in terms of medical expenditure is obvious. One third of patients who undergo surgery develop postoperative nausea and/or vomiting (PONV). The prevention of postoperative nausea and vomiting can improve satisfaction among vulnerable patients. The women were allocated randomly to two study groups according to the type of anesthesia administered (with and without midazolam). We suggest that midazolam has to be routinely included in the anesthesia protocol for short-term gynecological procedures (dilatation and curettage)

Methods

Results

Conclusion