Late Postoperative Nausea And Vomiting Research Articles

Retrospective Study on the Incidence of Postoperative Nausea and Vomiting and Hypotension During Orthognathic Surgery Using Propofol or Remimazolam

Objective This study aimed to evaluate the incidence of early (up to 2 h) and late (2–24 h) postoperative nausea and vomiting (PONV) and hypotension in patients who underwent general anesthesia for orthognathic surgery using propofol or remimazolam along with remifentanil. Methods This retrospective chart review included healthy adult patients under the age of 60 who underwent orthognathic surgery using propofol (P group) or remimazolam (R group) from January 2021 to March 2022. Records were reviewed to gather PONV and intraoperative hypotension data as well as patient characteristics and other variables. Results Early PONV was significantly lower in the P group vs the R group (9.5% vs 34.1%, respectively; P = .002), although the difference in late PONV was insignificant (36.9% vs 51.2%, respectively; P = .13). A higher incidence of intraoperative hypotension was noted in the P group (22.6%) vs the R group (2.4%; P = .004); however, there were no differences in average intraoperative systolic blood pressure or vasopressor administration. Conclusion These results suggest that propofol is associated with a lower incidence of early PONV as compared to remimazolam; however, antiemetics are still recommended given the frequency of late PONV in both groups. Propofol also caused more episodes of intraoperative hypotension vs remimazolam, but the increase in transient hypotension is likely to be irrelevant during orthognathic surgery in healthy adults under the age of 60.

Longer oxygen administration after surgery dose not reduce postoperative nausea and vomiting: An open label, clinical controlled study

BackgroundFrom previous studies, “intraoperative” supplemental oxygen did not seem to affect postoperative nausea and vomiting (PONV). However, less attention has been directed toward the relationship between “postoperative” oxygen administration and PONV. We have experienced some cases in which PONV was suppressed after oxygen was resupplied, and others in which PONV occurred immediately after stopping oxygen. Therefore, we hypothesized that administering oxygen postoperatively should have an antiemetic effect, and that longer postoperative oxygen administration should reduce PONV. MethodsThis study is a single-center, open label, and quasi-randomized controlled trial. Participants were patients undergoing laparoscopic gynecological surgery. They were randomly allocated to either a 1 h (1H) group or 5 h (5H) group according to their hospital ID number. The 1H group received oxygen for 1 h postoperatively; the 5H group received oxygen for 5 h. We investigated whether the duration of postoperative oxygen affects the likelihood of PONV under propofol-based general anesthesia. The primary outcome was the difference in overall incidence of nausea between the two groups. ResultsAfter excluding 168 patients before and after allocation, 628 patients for 1H patients and 588 patients for 5H were followed up and analyzed. The incidence of nausea was 44.1 % in the 1H group and 45.2 % in the 5H group (p = 0.73). No significant difference in early or late PONV was observed between the groups. ConclusionsLonger-duration postoperative oxygen administration did not reduce the incidence of PONV in patients undergoing laparoscopic gynecological surgery.

Effect of Dexamethasone in Management of Postoperative Nausea, Vomiting and Pain After Tonsillectomy in Paediatric Patients

Introduction: The effectiveness of dexamethasone (DEX) in reducing complication rates following paediatric tonsillectomy is still up for debate. The incidence of postoperative nausea and vomiting (PONV) and the severity of pain following paediatric tonsillectomy were examined by comparing concentrations of DEX 0.15 and DEX 0.5 mg/kg, respectively. Aim of the study: The aim of the study is to assess the effect of Dexamethasone in management of postoperative nausea, vomiting and pain after tonsillectomy where the targeted patients are of 3 to 10 years children. Methods: This prospective cross sectional study was conducted in the Department of Paediatric Anaesthesiology and Surgical ICU in Bangladesh Shishu Hospital and Institute, Dhaka, Bangladesh during July 2019 to June 2022. This study included 123 children undergoing elective tonsillectomy. The Institutional Ethics Committee approved this study and informed parental written consent was obtained from the parents before collecting the patients’ information. Results: The prevalence of early PONV was lower in both DEX groups (DEX 0.15: 22%; DEX 0.5: 26%; placebo: 48%; P=0.001). On the second day after surgery, the DEX groups had a lower rate of severe pain (DEX 0.15: 20%; DEX 0.5: 5%; placebo: 47%; P<0.001). The study was not conducted to assess a difference between the two dose groups of Dexamethasone. Conclusions: The frequency of early and late PONV and the level of pain on the second postoperative day were both reduced by an i.v injection of DEX during the induction of anesthesia. To reduce the incidence of PONV, it appeared that a dose of DEX 0.15 mg/kg was just as effective as a dose of DEX 0.5 mg/kg.

Risk factors for postoperative nausea and vomiting in patients of orthognathic surgery according to the initial onset time: a cross-sectional study.

A high incidence (40-73%) of postoperative nausea and vomiting (PONV) has been reported following orthognathic surgery, and various risk factors have been associated with it. Identifying PONV risk factors based on initial onset time will help establish preventive measures. This study aimed to identify factors that are significantly related to PONV based on the initial onset time after orthognathic surgery. This study included 590 patients who underwent orthognathic surgery. Multivariate logistic regression analysis was performed to identify the risk factors that are significantly related to PONV. The objective variables were classified into three categories: no PONV, early PONV (initial onset time: 0-2 h after anesthesia), and late PONV (initial onset time: 2-24 h after anesthesia). The explanatory variables included relevant risk factors for PONV, as considered in previous studies. Total intravenous anesthesia with propofol was a significant depressant factor for early PONV (adjusted odds ratio [aOR] = 0.340, 95% confidence interval [CI] = 0.209-0.555) and late PONV (aOR = 0.535, 95% CI = 0.352-0.814). The administration of a combination of intraoperative antiemetics (vs. no administration) significantly reduced the risk of early PONV (aOR = 0.464, 95% CI = 0.230-0.961). Female sex and young age were significant risk factors for late PONV (aOR = 1.492, 95% CI = 1.170-1.925 and unit aOR = 1.033, 95% CI = 1.010-1.057, respectively). We identified factors that are significantly related to PONV based on the initial onset time after orthognathic surgery. Total intravenous anesthesia with propofol significantly reduced the risk of PONV not only in the early period (0-2 h after anesthesia) but also in the late period (2-24 h after anesthesia).

Comparison of Low-Dose Promethazine and Dexamethasone against Ondansetron Monotherapy Given as Antiemetic Prophylaxis during Myomectomy Under Spinal Anesthesia: A Randomized Clinical Trial.

Postoperative nausea and vomiting (PONV) prophylaxis is still inadequate for a significant proportion of women undergoing myomectomy under spinal anesthesia; and it substantially decreases patient's quality of postoperative recovery. Current protocol and practice favor the use of combination therapy like promethazine/dexamethasone for PONV prophylaxis with minimal side effects and cost advantages in low-resource climes. Methodology. Seventy American Society of Anesthesiologist (ASA) class I or II women aged 21-65 years scheduled for myomectomy were recruited and randomized into group A (promethazine/dexamethasone group) and group B (ondansetron group). Myomectomy was performed on each patient using spinal anesthesia. After induction of spinal anesthesia, patients in group A received intravenous promethazine 12.5 mg and dexamethasone 8 mg while group B received intravenous ondansetron 8 mg. Early (0-3 h) and late (4-24 h) PONV was assessed using the numerical scoring scale. Data analysis was done using SPSS version 20. Postoperatively, there was no significant difference in the incidence of early ansd late PONV (p value >0.05) despite the higher incidents in the ondansetron group. The proportion of patients who required rescue antiemetics was more in the ondansetron group when compared with the promethazine/dexamethasone, with minimal and statistically insignificant side effects in both groups. There was significant patient satisfaction in both groups. The study shows that the combination of low-dose promethazine and dexamethasone is comparable to ondansetron when used as prophylaxis for PONV with cost benefits in low-resource environments.

Cross-sectional Study of PONV Risk Factors for Oral Surgery After Intubated General Anesthesia With Total Intravenous Anesthesia.

The incidence of postoperative nausea and vomiting (PONV) after general anesthesia with total intravenous anesthesia (TIVA) was reported to be significantly lower than with volatile inhalational agents (13.3% vs 25%). However, no investigation of PONV risk factors associated with TIVA has ever been reported. This cross-sectional retrospective study aimed to investigate whether known risk factors influenced PONV in intubated general anesthetics utilizing TIVA for dental or oral and maxillofacial surgery. Subjects were 761 patients who underwent dental or oral and maxillofacial surgery under TIVA with propofol, fentanyl, and remifentanil. Univariate and multivariable logistic regression analyses were performed using PONV (within 24 hours) as the dependent variable and previously reported risk factors as independent variables. Age (odds ratio [OR]: 1.020 per year decrease; 95% confidence interval [CI]: 1.0002-1.0418; P = .047) and female sex (OR: 2.73; 95% CI: 1.60-4.84; P < .001) were positively associated with PONV. Sagittal split ramus osteotomy (SSRO) (OR: 2.28; 95% CI: 1.21-4.33; P = .011) and bimaxillary osteotomy (OR: 5.69; 95% CI: 2.09-15.99; P < .001) were more likely to be associated with PONV than operations that were neither bimaxillary osteotomy nor SSRO. Late PONV (2-24 hours) had an ∼2.7 times higher incidence than early PONV (0-2 hours). These findings suggest further PONV countermeasures, aside from TIVA with propofol and prophylactic antiemetics for orthognathic surgeries especially bimaxillary osteotomy, are needed.

Perioperative dextrose infusion for prevention of postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy

Background and Aims: The effect of intravenous dextrose on the prevention of postoperative nausea and vomiting (PONV) is inconclusive. We aimed to determine the role of perioperative IV dextrose in the prevention of PONV and to analyze factors affecting PONV. Methods: This randomized, double-blind study was conducted in a tertiary care hospital. Two-hundred-fifty-five nondiabetic adults undergoing laparoscopic cholecystectomy were randomized into three groups (n = 85): group NS, group D5, and group D10 to receive perioperatively 250 mL of study fluid infusion (normal saline, dextrose 5%, and dextrose 10%, respectively). Nausea visual analog scale and PONV score, early (0–2 h) and late (2–24 h) PONV and rescue antiemetic treatment were assessed postoperatively. Statistical calculations were done using SPSS 17 version program for Windows. Results: Incidence of early and late PONV was significantly less in Groups D10 (25.9% and 2.4%, respectively) and D5 (43.5% and 17.6%, respectively) compared with Group NS (61.2% and 27.1%, respectively); P < 0.001. Postoperative PONV scores and the need for rescue antiemetics were significantly less in Groups D5 and D10 compared with Group NS; P < 0.05. After study fluid infusion, blood sugar levels (mg%) were significantly higher in patients in Group D10 (242.9 ± 26.2) compared with those who received NS (129.2 ± 10.8) or dextrose 5% (197.1 ± 20.8); P < 0.001. Factors associated with PONV were age, body mass index, female gender, increased anxiety and Apfel score, postoperative opioids, previous PONV, and blood sugar. Conclusions: Perioperative intravenous dextrose 5% (250 mL) can be considered the optimal dose for reducing the incidence and severity of PONV and antiemetic requirement in adults undergoing laparoscopic cholecystectomy.

Comparison between Dexamethasone Alone and its Combination with 5-Hydroxytryptamine Receptor Antagonist for Antiemesis during Laparoscopic Surgeries: A Double-blind Randomised Clinical Study

Introduction: Post operative nausea and vomiting (PONV) are often associated with the laparoscopic surgeries under general anesthesia (GA). The PONV guidelines recommended the use of 5-hydroxytryptamine receptor antagonist (5-HT3RA) as the first-line prophylactic agents in patients categorised as high-risk for emesis perioperatively. There are very few studies comparing the efficacies of combinations of newer 5HT3 RA with dexamethasone. Aim: To compare the severity of emetic episodes as well as the complete response rate to antiemetics like dexamethasone or its combination with palonosetron or ramosetron during the first 48 hours after laparoscopic surgeries. Materials and Methods: This randomised clinical double-blind study Department of Anesthesiology at Mysore Medical College and Research Institute, Mysuru, Karnataka, India, from November 2014 to August 2016 among 90 patients, aged between 18 to 60 years belonging to the American Society of Anesthesiology (ASA) grade I and II scheduled for elective laparoscopic surgery under general anesthesia. They were randomly allocated into three equal groups. Group D received dexamethasone 8 mg, group RD received ramosetron 0.3 mg with dexamethasone 8 mg, and group PD received palonosetron 0.075 mg with dexamethasone 8 mg. Postoperative Nausea and Vomiting (PONV), retching were recorded via direct questioning or by the spontaneous complaints from the patients at 2, 6, 24, 48 hours. A scoring system was used to assess PONV. Complete response rate was also noted i.e, percentage of patients in a group with absence of nausea, retching, vomiting and no requirement of rescue antiemetic medications within postoperative 48 hours. Results: The baseline characteristics were similar in all three groups. Early and late PONV were significantly lesser with group-PD compared to group D (p-value=0.01) and group RD (p-value=0.007). The complete response rate in group PD (86.6%) was significantly highest compared to group D (40%) and group RD (76%). Rescue anlgesics required was nil in group PD compared to group D (36.3%), and group RD (10%) over 48 hours. Conclusion: Combination of palonosetron with dexamethasone is a better alternative to combination of ramosetron with dexamethasone in preventing PONV.

Dexamethasone versus placebo for prevention of nausea, vomiting and pain after open total abdominal hysterectomy

Post-operative nausea and vomiting (PONV) is a disturbing issue. Dexamethasone has been suggested for the prevention of PONV. The aim of the present study was to evaluate the efficacy of dexamethasone as an anti-emetic and analgesic following total abdominal hysterectomy. The study was performed as a double blind, placebo-controlled randomised clinical trial on 102 women undergoing an open total abdominal hysterectomy. The intervention group received 8 mg dexamethasone 1 h before surgery, and the control group received a placebo. The total number of emesis episodes during the 24 h after surgery did not show significant difference between the two groups, however, the number of emesis episodes in hours 2 and 4 after the surgery were less in the intervention group, but not in hours 0, 6, 12 and 24. The nausea severity in hours 0, 2, 4, 6 and 12 after the surgery, was less in the intervention group. The severity of pain was not different between the two groups. IMPACT STATEMENT What is already known on this subject? Post-operative nausea and vomiting (PONV) is an important and disturbing issue. It is one of the most common problems following gynaecological surgeries including open total abdominal hysterectomy (TAH). Dexamethasone has been suggested as a prophylaxis for the prevention of PONV. What do the results of this study add? Dexamethasone 8 mg is effective for the prevention of late onset PONV (after 2 h of surgery) in the cases of open total abdominal hysterectomy. However, it has no effect on PONV immediately following surgery (hour 0) and pain. What are the implications of these findings for clinical practice and/or further research? Dexamethasone can be considered as an effective prophylaxis for PONV for the first 24 h after an open total abdominal hysterectomy, but it has limited effects on the management of early onset of PONV; between 0 and 2 h after surgery. Since the highest rates of emesis episodes and nausea severity are at this time, it is suggested to combine another rapid onset medication with dexamethasone. Also, dexamethasone, 8 mg, cannot be considered for pain relief after an open total abdominal hysterectomy. Higher amounts of dexamethasone should be evaluated for this purpose, in order to find appropriate dosages.

Transcutaneous electrical acupoint stimulation relieves post-operative nausea and vomiting possibly by reducing serum motilin secretion in patients undergoing laparoscopic surgery

To observe the effect of transcutaneous electrical acupoint stimulation (TEAS) of different acupoint combinations on postoperative nausea and vomiting (PONV) and serum motilin (MTL) content in patients undergoing laparoscopic surgery, so as to provide evidence for clinical selection of suitable acupoint compatibility. A total of 140 patients undergoing elective laparoscopic surgery were randomly divided into general anesthesia (GA) control, TG2 ［Neiguan (PC6) + Hegu (LI4)］, TG3 ［PC6 + LI4 + Zusanli (ST36)］, and TG4 ［PC6 + LI4 + ST36 + Sanyinjiao (SP6)］ groups, with 35 cases in each group. Patients of the TG2, TG3 and TG4 groups received TEAS (2 Hz/100 Hz, 3-8 mA) of the above mentioned acupoint (bilateral) groups for 30 min before the induction of anesthesia until the end of the operation. Patients of the GA control group received intravenous injection of Midazolam, Sufentanil, Propofol, Rocuronium Bromide, etc. The blood sample (4 mL) from the right median cubital vein was collected at the time of patient's entry, 12 and 24 h after surgery, respectively, for measuring MTL concentration by enzyme-linked immunosorbent assay. The incidence of early and late PONV and changes of PONV degree within 24 h after surgery were recorded. The serum MTL concentrations were significantly decreased at 12 h after surgery in all the 4 groups (P<0.05), and decreased at 24 h after surgery in GA and TG2 groups vs their own pre-surgery (P < 0.05), and considerably higher at both 12 and 24 h after surgery in the TG2, TG3 and TG4 groups than in the GA control group (P<0.05), and also evidently higher in the TG3 and TG4 groups than in the TG2 group (P<0.05). The incidence of PONV was significantly lower in the TG2, TG3 and TG4 groups than in the GA control group in the early and late periods (except TG2 group) of surgery (P<0.05). The number of patients with PONV grade Ⅰ was significantly larger in the TG2, TG3 and TG4 groups than in the GA control group at 24 h after surgery (P<0.05), suggesting a mild PONV in more patients undergoing TEAS. TEAS has a preventive effect on PONV in patients undergoing laparoscopic surgery, which may be related to its effect in reducing serum MTL concentration. The preventive effect of TEAS of PC6 + LI4 + ST36 and PC6 +LI4 + ST36 + SP6 is similar and better than TG2 (two acupoints) group.

Effects of menstrual cycle on nausea and vomiting after general anesthesia.

To investigate the impact of menstrual cycle on patients undergoing gynecological endoscopic surgery. 220 patients scheduled for gynecological endoscopic surgery under general anesthesia were selected. The patients were divided into three groups based on 3 phases of menstrual cycle which are the follicular phase (Group F), ovulatory phase (Group O) or luteal phase (Group L). It is based on their duration of menstruation and the last day of menstrual bleeding from the date of surgery. Primary outcomes were the incidences of early and late postoperative nausea and vomiting (PONV) in the three patient groups. Preoperative venous blood was taken to determine the estrogen and progesterone levels of the patients. A total of 207 patients were enrolled. The incidence of early PONV was highest in group O (22.22% vs 43.33% vs 17.86%, P < 0.01). Multivariate logistic regression showed that menstrual cycle (P < 0.01) and sufentanil dosage (P < 0.05) were independent risk factors for early PONV, menstrual cycle (P = 0.03) and intraoperative hypotension (P = 0.03) were independent risk factors for late PONV. After the propensity matching, the incidences of early and late PONV in group O were both higher than that in other two groups (19.23% vs 44.68% vs 16.90%, P < 0.01; 53.80% vs 72.34% vs 45.07%, P = 0.01). The incidence of PONV after gynecological endoscopic surgery was different in patients with different menstrual cycles, with the highest incidence in ovulation.

Nausea and vomiting in a colorectal ERAS program: Impact on nutritional recovery and the length of hospital stay

Postoperative nausea and vomiting (PONV) and its impact on the hospital length of stay (LOS), have been extensively studied. However, most previous publications focused their studies on PONV during the first 24h, and less is known about this complication during the ensuing days, its impact on nutritional recovery or its relation to other complications and the course of care. An observational study involving 806 consecutive patients in a colorectal Enhanced Recovery After Surgery (ERAS) programme was performed. The primary objective was to analyse the incidence of early PONV on the day of surgery and the following 2 postoperative days (late PONV). Secondary objectives included evaluation of the influence of late PONV over the LOS and the nutritional recovery adjusted for confounding factors. PONV tended to increase over time (7% vs 7% and 10%, postop days 0, 1 and 2, respectively; p<0.05). PONV on day 2 was associated in an adjusted analysis with poor oral intake, delayed solid food tolerance and an average increase in LOS of 2 nights. Risk factors for the presence of PONV on day 2 were the use of opioids on the same day, PONV on the day of the surgery and rectal procedures. PONV continues to be frequent after the first 24h in colorectal surgery despite high compliance to current anti emetic recommendations. PONV during day 2 negatively affects the nutritional postoperative recovery and independently prolongs the hospital stay. The findings of the current study highlight the adverse effects of opioids and the need of further discussion on how to best audit, prevent and treat late PONV in ERAS colorectal programmes.

A comparative study of the antiemetic effect of intravenous palonosetron with granisetron for the prevention of postoperative nausea and vomiting following laparoscopic cholecystectomy under general anesthesia

Background: Postoperative nausea and vomiting (PONV) is commonly experienced unpleasant complications of general anesthesia following laparoscopic cholecystectomy (LC). The present study was undertaken to compare the efficacy of palonosetron with granisetron in the prevention of PONV following LC under general anesthesia (GA). Materials and Methods: In a randomized, double-blinded study, after Ethical Committee approval, 100 adult patients aged 18–65 years, American Society of Anesthesiologists I/II undergoing elective LC under GA during a 2-year period in a Tertiary Care Hospital in Imphal were assigned into one of two groups. Group P (n = 50) received palonosetron 0.075 mg intravenous (IV) and Group G (n= 50) received granisetron 40 μg/kg body weight in 4 ml NS (0.9% normal saline added to get desired volume), 10 min before induction of anesthesia. Standardized anesthetic technique was used, and data were collected for PONV in postanesthesia care unit for 0–2 h and in the postoperative ward for 2–48 h. Results: The incidence of early PONV (0–2 h) was 28% in Group P (palonosetron) and 32% in Group G (granisetron), whereas the incidence of late PONV (2–48 h) was 18% in Group P and 32% in Group G. However, palonosetron had lesser delayed onset nausea (2–48 h) compared to granisetron (P = 0.037). Common side effects observed in the two groups were similar with no statistically significant difference between the groups. Conclusion: Prophylactic IV palonosetron was as effective as granisetron in preventing early (0–2 h) PONV. However, palonosetron was significantly better in the prevention of late onset nausea (2–48 h) in patients undergoing LC under GA without any major adverse effects.

Perioperative use of centrally acting angiotensin-converting enzyme inhibitor may increase patients’ risk for postoperative nausea and vomiting

Substance P (SP) is involved in the development of postoperative nausea and vomiting (PONV). It is hydrolyzed by angiotensin-converting enzyme (ACE). Centrally acting ACE inhibitors (CACE-Is) are widely used in the perioperative period. The current evidence showed CACE-Is could upregulate SP level in the central nervous system which may contribute to the occurrence of PONV in 0–72h. Here, we present our hypothesis that the use of CACE-Is in the perioperative period may increase patients’ risk for both early (0–24h) and late (24–72h) PONV. The identification of this new risk factor may improve patients’ risk assessment and thus lead to better prophylaxis strategies for PONV that are base on risk stratification.

Intravenous Delta-9-Tetrahydrocannabinol to Prevent Postoperative Nausea and Vomiting: A Randomized Controlled Trial.

Evidence suggests that cannabinoids can prevent chemotherapy-induced nausea and vomiting. The use of tetrahydrocannabinol (THC) has also been suggested for the prevention of postoperative nausea and vomiting (PONV), but evidence is very limited and inconclusive. To evaluate the effectiveness of IV THC in the prevention of PONV, we performed this double-blind, randomized, placebo-controlled trial with patient stratification according to the risk of PONV. Our hypothesis was that THC would reduce the relative risk of PONV by 25% compared with placebo. With IRB approval and written informed consent, 40 patients at high risk for PONV received either 0.125 mg/kg IV THC or placebo at the end of surgery before emergence from anesthesia. The primary outcome parameter was PONV during the first 24 hours after emergence. Secondary outcome parameters included early and late nausea, emetic episodes and PONV, and side effects such as sedation or psychotropic alterations. The relative risk reduction of overall PONV in the THC group was 12% (95% confidence interval, -37% to 43%), potentially less than the clinically significant 25% relative risk reduction demonstrated by other drugs used for PONV prophylaxis. Calculation of the effect of treatment group on overall PONV by logistic regression adjusted for anesthesia time gave an odds ratio of 0.97 (95% confidence interval, 0.21 to 4.43, P = 0.97). Psychotropic THC side effects were clinically relevant and mainly consisted of sedation and confusion that were not tampered by the effects of anesthesia. The study was discontinued after 40 patients because of the inefficacy of THC against PONV and the finding of clinically unacceptable side effects that would impede the use of THC in the studied setting. Because of an unacceptable side effect profile and uncertain antiemetic effects, IV THC administered at the end of surgery before emergence from anesthesia cannot be recommended for the prevention of PONV in high-risk patients.

The effects of dexamethasone and metoclopramide on early and late postoperative nausea and vomiting in women undergoing myomectomy under spinal anaesthesia.

Post-operative nausea and vomiting (PONV); early or late, has detrimental effects on surgical patients such as surgical wound disruption, esophageal tear and delayed discharge from the post anesthetic care unit. This study evaluated the effects of dexamethasone-metoclopramide (DM) in the prevention of early and late PONV in women undergoing myomectomy under subarachnoid block. Following approval from the Research and Ethics Committee of the Hospital, informed consent was obtained from each prospective patient. Patients were randomly allocated to either the DM group, metoclopramide only (MO) group or dexamethasones only (DO) group using the computer-generated random numbers in sealed envelopes. Immediately after the induction of spinal anesthesia, the DM group received intravenous (i.v.) dexamethasone 8 mg and metoclopramide 10 mg, the MO group received metoclopramide 10 mg i.v and the DO group received dexamethasone 8 mg i.v. The incidence of early and late PONV formed the primary outcome. A total of 90 patients, with aged range between 21-64 years were studied. Dexamethasone alone group had the highest incidence of 40% for early but no for late PONV ( P = 0.003) Metoclopramide alone group had an incidence of 29.97% for early PONV and 26.6% for late PONV. There was reduced incidence of both early and late PONV in the DM group, but of lesser magnitude than DO or MO respectively. Dexamethasone protects against the incidence of late PONV with a minimal effect on early PONV. The combination of dexamethasone and metoclopramide had comparable effect on both and of better magnitude than metoclopramide alone.

Effect of Dexamethasone on Nausea, Vomiting, and Pain in Paediatric Tonsillectomy

Hermans, V.*; De Pooter, F.*; De Groote, F.*; De Hert, S.†; Van Der Linden, P.* Author Information

Postoperative nausea and vomiting prophylaxis: The efficacy of a novel antiemetic drug (palonosetron) combined with dexamethasone

BackgroundPalonosetron is a new, potent, and long-acting 5HT3-receptors antagonist that had been approved by the FDA for use in postoperative nausea and vomiting (PONV) prophylaxis. This study is designed to evaluate its efficacy combined with dexamethasone in PONV prophylaxis in highrisk patients scheduled for laparoscopic surgeries.MethodsIn this double-blind, active-controlled study, 150 patients aged 20–55 years, ASA I–II, and with Apfel’s PONV score 2–4 were equally randomized to receive dexamethasone 8 mg before anesthesia induction and saline 30 min before the end of surgery (group D + S), dexamethasone 8 mg before anesthesia induction and metoclopramide 25 mg 30 min before the end of surgery (group D + M), or dexamethasone 8 mg combined with palonosetron 0.075 mg before anesthesia induction and saline 30 min before the end of surgery (group D + P). Incidences of early and late PONV, complete response, adverse events from antiemetics used, and overall patients’ satisfaction were recorded.ResultsThe incidence of PONV was comparable in the three groups 0–6 h postoperatively. Palonosetron–dexamethasone and dexamethasone–metoclopramide combination therapies significantly reduced the incidence of PONV at 6–12 h postoperatively compared to dexamethasone monotherapy (12% and 16%, vs. 36%, respectively, with P < 0.05). Moreover, palonosetron–dexamethasone combination therapy significantly reduced the incidence of PONV at 12–24 h postoperatively compared to both dexamethasone monotherapy (16% vs. 48%, P < 0.01), and dexamethasone–metoclopramide combination therapy (16% vs. 40%, P < 0.05). The incidence of adverse drug effects was comparable in the three groups. The overall patients’ satisfaction was significantly higher in palonosetron–dexamethasone combination therapy compared to other groups.ConclusionPalonosetron–dexamethasone combination is effective and safe in PONV (early and late) prophylaxis in high-risk patients undergoing laparoscopic surgeries with known high-risk of PONV.

A comparative study between ramosetron and granisetron for the prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy

Background: The reported incidence of postoperative nausea and vomiting (PONV) following laparoscopic cholecystectomy (LC) is very high. Various treatment modalities have been tried by several workers with varying results. This study was undertaken to compare the efficacy of ramosetron and granisetron with the intention to prevent postoperative nausea and vomiting (PONV) after laparoscopic cholecystectomy in this part of the country. Materials and Methods: In a randomized, double-blind study in our tertiary care hospital, 80 inpatients of ASA I and II were enrolled and received either 3 mg granisetron or 0.3 mg ramosetron i.v. (n = 40 each) ten minutes before induction of anesthesia. Standardized anesthetic technique was used, and data was collected for early (0-2 hr) PONV in the post-anesthetic care unit (PACU) and late (2-24 hr) PONV in the ward. Results: The incidence of early PONV (0-2 hr) was 22.5% for granisetron and 15% for ramosetron (P > 0.05; 95% Confidence interval (CI) = 0.20 to 1.97; OR = 0.63), late PONV (2-24 hr) was 25% and 15%, respectively (P > 0.05; CI = 0.18 to 1.68; OR = 0.56). The most common side-effects observed in the two groups were headache and drowsiness, and these were mild and self-limiting. There was no significant difference in the side-effects of drugs between the two groups. Conclusion: PONV is a distressing symptom in laparoscopic cholecystectomy cases, and ramosetron is as effective as granisetron in preventing early (0-2 hr) and late (2-24 hr) PONV.

Comparison of the antiemetic effect of ramosetron with the combination of dexamethasone and ondansetron in middle ear surgery: A double-blind, randomized clinical study

Background:Postoperative nausea and vomiting (PONV) is a frequent complication of middle ear surgery. Ondansetron has been shown to be effective for early PONV and dexamethasone has been shown to be effective for late PONV. Therefore, a combination of dexamethasone and ondansetron is commonly used for middle ear surgery. This study was conducted to compare the combination of ondansetron and dexamethasone with ramosetron for early and late PONV up to 48 h after middle ear surgery.Methods:One hundred and twenty adults scheduled for middle ear surgery were allocated to receive either dexamethasone 8 mg and ondansetron 4 mg (n=60) or ramosetron 0.3 mg (n=60). General anesthesia with inhalation agents was used for all the patients. The incidence and severity of PONV, administration of rescue antiemetic, and the side effects of the antiemetic were documented during the first 48 h after surgery.Results:The incidence of nausea was significantly lower in the dexamethasone and ondansetron group compared to the ramosetron group between 2 and 24 h. The complete response, which is patients with no nausea or vomiting, was significantly more in dexamethasone and ondansetron group compared to ramosetron group between 2 and 24 h and between 24 and 48 h (76% vs. 56%, P=0.02, 93% vs. 81%, P=0.05, respectively). Overall, complete response was more in dexamethasone and ondansetron group compared to ramosetron group (71% vs. 40%, P=0.01).Conclusion:The combination of dexamethasone and ondansetron is superior to ramosetron for prevention of PONV after middle ear surgeries.