Prevention Of PONV Research Articles

Sub-hypnotic dose of propofol as antiemetic prophylaxis attenuates intrathecal morphine-induced postoperative nausea and vomiting, and pruritus in parturient undergoing cesarean section \u2014 a randomized control trial

BackgroundPostoperative Nausea and Vomiting (PONV) is a dreadful and uncomfortable experience that significantly detracts patients’ quality of life after surgery. This study aimed to examine the antiemetic effect of a single sub-hypnotic dose of propofol as prophylaxis for PONV.MethodIn this prospective, double-blind, randomized control trial, 345 parturients presented for elective cesarean section at the Obstetric unit of Tamale Teaching Hospital were recruited. Each recruited parturient was randomly assigned to one of three groups; Propofol group (n = 115) represented those who received propofol 0.5 mg/kg, Metoclopramide group (n = 115) represented those who received metoclopramide 10 mg and, Control group (n = 115) represented those who received 0.9% saline. Spinal anesthesia with 0.5% hyperbaric bupivacaine 7.5–10 mg, and intrathecal morphine 0.2 mg was employed for the anesthesia.ResultsThe data indicate that 108 (93.9%) parturients from the control group, 10 (8.7%) from the propofol group and 8 (7.0%) from the metoclopramide group experienced some incidence of PONV. There was no significant difference in the incidence of PONV (nausea, vomiting, and none) between the propofol and the metoclopramide groups (P = 0.99; 0.31; and 0.35 respectively). Parturients who received antiemetic agents were 105 (97.2%), 1 (10.0%) and 3 (37.5%) from the control, propofol and metoclopramide groups respectively. The data indicated that 98 (85.2%) parturients from the control, 3 (2.6%) from propofol group, and 100 (87.0%) from the metoclopramide group experienced some levels of pruritus. There was a significant difference in the incidence of pruritus (mild, moderate, and no pruritus) between the metoclopramide and propofol groups (P < 0.01; P < 0.01; and P < 0.01 respectively).ConclusionA sub-hypnotic dose of propofol is effective as metoclopramide in the prevention of PONV in parturient undergoing cesarean section under spinal anesthesia with intrathecal morphine. Sub-hypnotic dose of propofol significantly reduces the incidence of postoperative pruritus following intrathecal morphine use.Trial registrationCurrent control trial, registered at ISRCTN trial registry: ISRCTN15475205. Date registered: 03/04/2019. Retrospectively registered.

Comparison of ondansetron, tropisetron, and palonosetron for the prevention of postoperative nausea and vomiting after middle ear surgery

BackgroundPostoperative nausea and vomiting (PONV) are 2 of the most frequent adverse effects of anesthesia. PONV prolongs hospital stays and also delays the recovery of patients.ObjectiveIn this study, the effects of ondansetron, tropisetron, and palonosetron on PONV in patients who had undergone middle ear surgeries such as mastoidectomy or tympanoplasty were compared.MethodsThe study included 165 American Society of Anesthesiologists grade 1 and 2 patients aged 18 to 65 years. Patients were randomized into 3 groups by a closed envelope method. Neither the patients nor the nurses administering the treatments knew which patient belonged to which group. The anesthetic technique was standardized for all groups. During skin closure, 0.075 mg palonosetron, 5 mg tropisetron, and 8 mg ondansetron were administered intravenously to the palonosetron, tropisetron, and ondansetron groups, respectively. After completion of the surgery, the patients were followed for 48 hours. Diclofenac sodium (100 mg IM) was administered to patients experiencing pain and metoclopramide chloride (10 mg IM) was administered to patients with nausea or vomiting. Potential side effects such as headache and constipation were recorded in the postanesthesia care unit and ear, nose, and throat clinic.ResultsThere was no significant difference in the effects of all 3 antiemetic agents on the severity of PONV (P = 0.081). At 48 hours postoperatively, the incidence of PONV was significantly lower in the palonosteron group (38.2%) than the ondansetron group (63.6%) and tropisetron group (61.8%) (P = 0.011). At 48 hours postoperatively, the incidence of postoperative nausea was significantly lower in the palonosetron group (32.7%) than in the ondansetron group (63.6%) and the tropisetron group (56.4%) (P = .003). The incidence of PONV between hours 12 and 24 postoperatively was significantly higher in the ondansetron group (27.3%) than in the palonosetron group (9.1%) (P = 0.013). The antiemetic requirement in the first hour after surgery was significantly higher in the tropisetron group (25.5%) than in the palonosetron group (7.3%) (P = .019).ConclusionsThe results of the current study support those of earlier studies that suggest that palonosetron was statistically more effective than the other 2 formulations in the prevention of PONV in patients who have undergone middle ear surgery. (Curr Ther Res Clin Exp. 2019; 80:XXXXXX).

Effect of oral ginger on prevention of nausea and vomiting after laparoscopic cholecystectomy: a double-blind, randomized, placebo-controlled trial.

BackgroundPostoperative nausea and vomiting (PONV) are among the most frequent complications following laparoscopic cholecystectomy. Recently, some studies have shown ginger, as an herbal medicine, to be effective and safe in PONV prevention; however, there is no evidence of its efficacy in the Iranian population.ObjectiveThe aim of this study was to determine the effect of oral ginger on PONV prevention after laparoscopic cholecystectomy.MethodsThis double-blind, randomized, placebo-controlled clinical trial was performed on women who were undergoing laparoscopic cholecystectomy in Imam Raza Hospital, Mashhad, Iran between April and November, 2016. Patients were divided randomly into two groups of G) intervention group (n=75, received 2 capsules containing 250 mg ginger) and P) placebo group (n=75, received 2 placebo capsules) one hour before surgery. Nausea severity and vomiting frequency were evaluated at 2, 4, 6, and 12 hours after the operation. Data analysis was done by SPSS version 16.0 software with Chi-square test, Independent-sample-t-test, repeated measure ANOVA and Mann–Whitney U test.ResultsThe two groups were homogenous in terms of age, gender and surgery duration. The severity of nausea was lower in the ginger group at the 2, 4, 6, and 12 hours after the operation; however, these differences were statically significant only at 2 (p=0.034) and 12 hours (p=0.043). Although the incidence of vomiting was higher in the placebo group in the 2nd and 12th hours after surgery, the number of vomiting episodes in 2, 4, 6 and 12 hours after surgery was statistically similar in the two groups (p>0.05). The nausea severity was significantly changed during 12 hours of study in both groups (p=0.001), however the nausea severity was always lower in the ginger group (p=0.078).ConclusionThis study demonstrated that 500mg oral ginger one hour before surgery in women who were undergoing laparoscopic cholecystectomy is effective in decreasing severity of PONV.Trial registrationThe trial was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the Irct ID: IRCT2016122222218N2.FundingThe study was financially supported by Deputy of Research of Mashhad University of Medical Sciences.

Sustainability of anaesthesia components of an enhanced recovery program (ERP) in colorectal and orthopaedics surgery

BackgroundSustainability of ERP is a challenge and data are scarce on the subject. The aim of this study was to assess if application of enhanced recovery elements through the Francophone Group of Enhanced Recovery after Surgery (Grace) in the anaesthesia management was sustainable 2 years after its implementation. Materials and methodsWe conducted a retrospective analysis of the prospective Grace database between October 2014 and October 2016. The evolution of each recommendation item over time was analysed using non-parametric Spearman correlation coefficient. ResultsA total of 67 and 43 centres corresponding to 2067 and 3022 patients participated to the Grace audit in colorectal and orthopaedics surgery, respectively. Colorectal surgery: Mean length of stay was 5 (±4) days and readmission rate was 6.6%. Application of most items did not statistically change. It worsened over time for PONV prophylaxis (P=0.01) and prevention of intraoperative hypothermia (P=0.02); and improved for NSAID administration (P=0.01). Orthopaedics surgery: Mean length of stay was 3 (±2) days and readmission rate was 1.7%. There was a trend towards improvement for most items. It reached statistical significance for PONV prophylaxis (P=0.001), limited preoperative fasting (P=0.01). While the use of a perineural catheter (P=0.001) decreased over time, infiltration of the surgical site statistically increased (P=0.05). ConclusionThis study shows on a large scale a trend towards less application of all ERP items over time. Continuous audits should be encouraged to expect further improvements.

Évaluation de la mise en place d’un protocole de réhabilitation précoce postcésarienne

ObjectiveTo evaluate the implementation of a protocol of enhanced recovery for elective cesarean section in a level III maternity. MethodsThis is a prospective observational study such as “before/after” on the implementation of a protocol of enhanced recovery for elective cesarean section from January 1st to December 31st, 2015, in a level III obstetrics unit French maternity. Patients were separated in 2 groups: women who benefit from enhanced recovery protocol after the first of July compared to women who underwent the conventional protocol between January 1st and June 30th, 2015. Inclusion criteria included: performing an emergency or scheduled cesarean, in patients with medical history congruent with the possible hospital release at day three. Demographic and obstetrics data were gathered. Items of the protocol, adverse and secondary effects as well as, postoperative complications were collected. ResultsFrom January 1st to December 31st 2015, 408 patients were included in this study, 202 in the conventional arm protocol and 206 in the enhanced recovery protocol. Early rehabilitation protocol has been achieved for 25.7 % patients (n=105) with 18.1 % (n=19) before the establishment of the protocol and 81.9 % (n=86) after creation of the latter. Prevention of PONV by dexamethasone and droperidol was performed before and after creation of the protocol in 5.3 % (n=1) and 51.2 % of cases (n=44) (P<0.05), respectively. There were no significant differences between the 2 groups regarding the removal of the urinary catheter (94.7 % versus 76 %, P=0.14) or the shutter venous catheter SSPI (78.9 % vs 73 %, P=0.82). Administration of drinks H1 and H4 first meal were routinely performed after the creation of the protocol (52.6 % vs 100 %, P<0.05 and 63.1 % vs 100 %, P<0.05). An early rise in the first 12hours was usually performed after the drafting of the protocol (78.9 % versus 92 %, P<0.05). Average hospital stay was shorter after the establishment of early rehabilitation protocol (4 versus 5.5 days, P<0.05). ConclusionEarly rehabilitation protocol was applied safely. It resolved in good management of pain, nausea and vomiting in postoperative. It participated in reducing adverse outcomes that could slow recovery and therefore allowed earlier hospital discharge, while maintaining high level of satisfaction with their care.

Herbal medications for surgical patients: a systematic review protocol

IntroductionPostoperative nausea and vomiting (PONV) affect approximately 80% of surgical patients and is associated with increased length of hospital stay and systemic costs. Preoperative and postoperative pain, anxiety and depression...

A Clinical Comparative Study of Ondansetron, Palonosetron, Ramosetron, and Metoclopramide for Prevention of Postoperative Nausea and Vomiting in Patients undergoing Laparoscopic and ENT Surgery under General Anesthesia

ABSTRACT Introduction Postoperative nausea and vomiting (PONV) is a well-known entity following surgical procedures and may result in serious complications including aspiration of gastric contents, prolonged recovery period, and impaired surgical wound healing. Laparoscopic surgery is a known risk factor for PONV. Also, the incidence of vomiting after ear nose throat (ENT) surgeries is relatively high. Aims and Objectives Our aim of the study is to compare the effectiveness of ondansetron, palonosetron, ramosetron, and metoclopramide to prevent PONV in patients undergoing laparoscopic and ENT surgery under general anesthesia. Materials and methods The present study was conducted on 120 adult patients scheduled for elective laparoscopic chole­cystectomy and ENT surgery under general anesthesia. All patients were randomized into four groups (O, P, R, and M) with 30 patients each and received injection ondansetron (4 mg), palonosetron (0.075 mg), ramosetron (0.3 mg), and metoclopramide (10 mg) intravenously during premedication. Patients were observed intraoperatively and 24 hours postoperatively for any episodes of nausea and vomiting. All the patients were observed for side effects, such as dizziness, headache, allergic reactions, etc. Conclusion Palonosetron is quite effective in prevention of PONV compared with ramosetron, ondansetron, and metoclopramide given intravenously for various surgical procedures under general anesthesia. Its effectiveness in PONV provides a new cost-effective agent to the present recital of antiemetic drugs. How to cite this article Vinay V, Agrawal AP, Verma AP, Krishan G, Ahmad R, Hanjura S. A Clinical Comparative Study of Ondansetron, Palonosetron, Ramosetron, and Metoclopramide for Prevention of Postoperative Nausea and Vomiting in Patients undergoing Laparoscopic and ENT Surgery under General Anesthesia. Int J Adv Integ Med Sci 2017;2(2):65-69.

Évaluation de la mise en place d’un protocole de réhabilitation précoce postcésarienne

ObjectiveTo evaluate the implementation of a protocol of enhanced recovery for elective cesarean section in a level III maternity. MethodsThis is a prospective observational study such as “before/after” on the implementation of a protocol of enhanced recovery for elective cesarean section from January 1st to December 31st, 2015, in a level III obstetrics unit French maternity. Patients were separated in 2 groups: women who benefit from enhanced recovery protocol after the first of July compared to women who underwent the conventional protocol between January 1st and June 30th, 2015. Inclusion criteria included: performing an emergency or scheduled cesarean, in patients with medical history congruent with the possible hospital release at day three. Demographic and obstetrics data were gathered. Items of the protocol, adverse and secondary effects as well as, postoperative complications were collected. ResultsFrom January 1st to December 31st 2015, 408 patients were included in this study, 202 in the conventional arm protocol and 206 in the enhanced recovery protocol. Early rehabilitation protocol has been achieved for 25.7 % patients (n=105) with 18.1 % (n=19) before the establishment of the protocol and 81.9 % (n=86) after creation of the latter. Prevention of PONV by dexamethasone and droperidol was performed before and after creation of the protocol in 5.3 % (n=1) and 51.2 % of cases (n=44) (P<0.05), respectively. There were no significant differences between the 2 groups regarding the removal of the urinary catheter (94.7 % versus 76 %, P=0.14) or the shutter venous catheter SSPI (78.9 % vs 73 %, P=0.82). Administration of drinks H1 and H4 first meal were routinely performed after the creation of the protocol (52.6 % vs 100 %, P<0.05 and 63.1 % vs 100 %, P<0.05). An early rise in the first 12hours was usually performed after the drafting of the protocol (78.9 % versus 92 %, P<0.05). Average hospital stay was shorter after the establishment of early rehabilitation protocol (4 versus 5.5 days, P<0.05). ConclusionEarly rehabilitation protocol was applied safely. It resolved in good management of pain, nausea and vomiting in postoperative. It participated in reducing adverse outcomes that could slow recovery and therefore allowed earlier hospital discharge, while maintaining high level of satisfaction with their care.

Postoperative nausea and vomiting after thyroidectomy: a comparison between dexmedetomidine and remifentanil as part of balanced anesthesia.

BackgroundPostoperative nausea and vomiting (PONV) is the major complication related to general anesthesia, occurring in 60–80% of patients after thyroidectomy. The objective of this study was to compare the effects of an intraoperative dexmedetomidine infusion with remifentanil, as anesthetic adjuvants of balanced anesthesia, on PONV in patients undergoing thyroidectomy.MethodsEighty patients scheduled for thyroidectomy were randomized into the following two groups: 1) The dexmedetomidine group (Group D), who received an initial loading dose of dexmedetomidine (1 µg/kg over 10 min) during the induction of anesthesia, followed by a continuous infusion at a rate of 0.3–0.5 µg/kg/h; 2) the remifentanil group (group R), who received remifentanil at an initial target effect site concentration of 4 ng/ml during the induction of anesthesia, followed by a target effect site concentration of 2–3 ng/ml. PONV was assessed during the first 24 hours in 2 time periods (0–2 h and 2–24 h). The pain intensity, sedation score, extubation time, and hemodynamics were also assessed.ResultsDuring the 2 time periods, the incidence and severity of PONV in group D were significantly lower than in group R. In addition, the need for rescue antiemetics was significantly lower in group D than in group R. The effect of dexmedetomidine on postoperative pain relief (2–24 h) was superior to that of remifentanil. The hemodynamics were similar in both groups, whereas eye opening and extubation time were delayed in group D.ConclusionsAdjuvant use of intraoperative dexmedetomidine infusion may be effective for the prevention of PONV.

Prophylaxis of postoperative nausea and vomiting with combination of ondansetron and dexametasone in urology: Prophylaxis of postoperative nausea and vomiting

Introduction: Postoperative nausea and vomiting is an unpleasant, distressing and exhausting experience for patients. There are inconsistent findings concerning approach to the management of PONV and disagreement as to whether prophylaxis of PONV should be the standard of care. Antiemetic prophylaxis using the ondansetron (serotonin subtype 3 antagonist), that is primarily used in the therapy of chemotherapy-induced nausea and vomiting, alone results in a relative reduction rate of PONV of about 30%. It is also well known that dexamethasone, a corticosteroid, is an effective antiemetic agent with minimal side effect after single dose administration in prevention of PONV. Aim of this study was to evaluate the prophylactic effect of ondansetron combined with dexamethasone to prevent PONV in patients undergoing urological surgery. Methods: 60 patients scheduled for an elective surgery (nephrectomy) were involved in this study. Group one (n = 30) received dexamethasone at dose of 5 mg iv. after induction in general anesthesia and 4 mg iv. ondansetron 15 min before end of surgery. Group two (n = 30) was control group and they recieved only our standard antiemetic drug (metoclopramide) in case of PONV. The patients were observed for PONV symptoms during 24 hours after surgery. PONV in groups were evaluated by following parameters: incidence and intensity of PONV, frequency of emetic episodes, VAS pain and fatigue, rescue emetics, and stay in hospital. Results: There is statistical difference in occurring emetic episodes during first 8 hours postoperatively with no demographic influence on study results. Conclusion: Prophylactic dose ondansetron 4mg i.v. + dexamethason 5mg i.v. is effective combination that significantly reduces incidence of PONV in patients undergoing urological surgery.

The effect of combination treatment using palonosetron and dexamethasone for the prevention of postoperative nausea and vomiting versus dexamethasone alone in women receiving intravenous patient-controlled analgesia.

BackgroundThe purpose of this study was to evaluate the effect of palonosetron combined with dexamethasone for the prevention of PONV compared to dexamethasone alone in women who received intravenous patient-controlled analgesia (IV-PCA) using fentanyl.MethodsIn this randomized, double-blinded, placebo-controlled study, 204 healthy female patients who were scheduled to undergo elective surgery under general anesthesia followed by IV-PCA for postoperative pain control were enrolled. Patients were divided into two groups: the PD group (palonosetron 0.075 mg and dexamethasone 5 mg IV; n = 102) and the D group (dexamethasone 5 mg IV; n = 102). The treatments were given after the induction of anesthesia. The incidence of nausea, vomiting, severity of nausea, and the use of rescue anti-emetics during the first 48 hours after surgery were evaluated.ResultsThe incidence of PONV was significantly lower in the PD group compared with the D group during the 0-24 hours (43 vs. 59%) and 0-48 hours after surgery (45 vs. 63%) (P < 0.05). The severity of nausea during the 6-24 hours after surgery was significantly less in the PD group compared with the D group (P < 0.05). The incidence of rescue antiemetic used was significantly lower in the PD group than in the D group during the 0-6 hours after surgery (13.1 vs. 24.5%) (P < 0.05).ConclusionsPalonosetron combined with dexamethasone was more effective in preventing PONV compared to dexamethasone alone in women receiving IV-PCA using fentanyl.

Comparision of propofol and dexamethasone in PONV prevention after adenotonsillectomy in children

Comparision of propofol and dexamethasone in PONV prevention after adenotonsillectomy in children

Dexamethasone reduces nausea and vomiting but not pain after thyroid surgery: a meta-analysis of randomized controlled trials.

BackgroundPostoperative nausea and vomiting (PONV) is a common complication after thyroidectomy. The aim of this article was to evaluate the efficacy of dexamethasone for prevention of PONV and pain in patients undergoing thyroidectomy.Material/MethodsWe performed this meta-analysis based on the QUORUM (Quality of Reporting of Meta-analyses) guidelines. Our study included randomized controlled trials (RCTs) that compared preoperative single-dose administration of dexamethasone with no dexamethasone in patients undergoing thyroidectomy. The primary outcome was occurrence and severity of PONV, and the secondary outcomes included pain, use of analgesics, and steroid-related complications.ResultsSeven RCTs were included, with a total of 611 patients. A statistically and clinically significant difference in the incidence and severity of PONV was found in favor of dexamethasone (SMD, 0.23; 95% CI, 0.13–0.41; P<0.00001; SMD, 0.53; 95% CI, −1.03 to −0.03; P=0.04). However, there was no significant difference in reduction of pain severity and analgesic consumption in using dexamethasone (SMD, −0.83; 95% CI, −1.85 to 0.18; P=0.14; SMD, −0.19; 95% CI, −0.43 to 0.04; P=0.10). No steroid-related complications were noted.ConclusionsA single preoperative administration of dexamethasone reduced the incidence and severity of PONV but not pain severity and analgesic consumption in patients undergoing thyroidectomy. Further studies with a larger sample size are needed to further explore the efficacy of dexamethasone on postoperative pain severity and analgesic consumption.

Guidelines for perioperative care after radical cystectomy for bladder cancer: Enhanced Recovery After Surgery (ERAS®) society recommendations

Enhanced recovery after surgery (ERAS) pathways have significantly reduced complications and length of hospital stay after colorectal procedures. This multimodal concept could probably be partially applied to major urological surgery. The primary objective was to systematically assess the evidence of ERAS single items and protocols applied to cystectomy patients. The secondary objective was to address a grade of recommendation to each item, based on the evidence and, if lacking, on consensus opinion from our ERAS Society working group. A systematic literature review was performed on ERAS for cystectomy by searching EMBASE and Medline. Relevant articles were selected and quality-assessed by two independent reviewers using the GRADE approach. If no study specific to cystectomy was available for any of the 22 given items, the authors evaluated whether colorectal guidelines could be extrapolated. Overall, 804 articles were retrieved from electronic databases. Fifteen articles were included in the present systematic review and 7 of 22 ERAS items were studied. Bowel preparation did not improve outcomes. Early nasogastric tube removal reduced morbidity, bowel recovery time and length of hospital stay. Doppler-guided fluid administration allowed for reduced morbidity. A quicker bowel recovery was observed with a multimodal prevention of ileus, including gum chewing, prevention of PONV and minimally invasive surgery. ERAS has not yet been widely implemented in urology and evidence for individual interventions is limited or unavailable. The experience in other surgical disciplines encourages the development of an ERAS protocol for cystectomy.

Improving Prevention and Treatment of PONV

Improving Prevention and Treatment of PONV

Retraction Note to: Prevention of PONV with granisetron, droperidol or metoclopramide in patients with postoperative emesis

Retraction Note to: Prevention of PONV with granisetron, droperidol or metoclopramide in patients with postoperative emesis

Implementation of the Aspan Evidence–Based Clinical Practice Guidelines for the Prevention and/or Management of PONV/PDNV in an Ambulatory Surgical Population

ASPAN published clinical practice guidelines for the prevention and management of PONV /PDNV in 2006. These guidelines identified the feasibility of guideline implementation and the impact of guidelines on expected patient outcomes as priorities for research. ASPAN also recognizes studies examining the effect of use of its clinical practice guidelines on patient outcomes as one of its top ten research priorities.

PONV prevention: Colloids vs normal saline in anesthesia for brain tumor resection

University Clinical Centre ‘Mother Theresa’, Department of Anaesthesiology and Intensive Care, Tirana, Albania

Different Doses of Palonosetron for the Prevention of Postoperative Nausea and Vomiting in Children Undergoing Strabismus Surgery

Objective: The aim of this study was to evaluate the efficacy of different doses of palonosetron for the prevention of PONV in children undergoing strabismus surgery. Patients and Method: A total of 150 children who were classified with an American Society of Anesthesiologists physical status of I, were aged between 2 and 12 years, and were undergoing strabismus surgery under general anesthesia were enrolled in the study. A random numbers table was used to assign each child to receive palonosetron 0.5, 1.0, or 1.5 μg/kg (n = 50 in each group).All episodes of PONVat the intervals of 0–2, 2–6, 6–24, and 24–48 hours were evaluated using a numeric scoring system for PONV. A p-value of <0.05 was considered statistically significant. Results: The percentage of children with PONV during 0–48 hours after anesthesia was 24% with palonosetron 0.5 or 1.0 μg/kg, and 20% with palonosetron 1.5 μg/kg. There was no statistically significant difference between the study groups with respect to the number of children with PONV scores of 1, 2, or 3 during 0–48 hours after anesthesia. There was no statistically significant difference between the study groups with respect to the number of children with postoperative vomiting during all time periods after anesthesia. The percentage of children aged >6 years with postoperative nausea during 0–48 hours after anesthesia was 8.6%, 18.2%, and 15.4% with palonosetron 0.5, 1.0, or 1.5 μg/kg, respectively, but there was no statistically significant difference between the study groups. Conclusion: Palonosetron doses of 0.5, 1.0, and 1.5 μg/kg are recommended for further evaluation, as they appear to be the effective doses for the prevention of PONV following strabismus surgery in children.

POSTOPERATIVE NAUSEA AND VOMITING (PONV)

Objective: To evaluate the effect of preoperative single dose injection dexamethasone for prevention of PONV in patients undergoing laparoscopic cholecystectomy and comparing it with normal saline (placebo). Design: Experimental RCT study. Place and duration of study: The study was conducted at Madina Teaching hospital, University Medical &amp; Dental College, Faisalabad from January, 2008 to October 2009. Materials and Methods: After approval from the hospital ethical committee, 200 patients with ASA I &amp; II were included in the study. We divided the patients into two groups; group I received preoperative dexamethasone (8mg) and the group II received normal saline (placebo) 90 minutes before the surgery. Patients were observed for any episodes of nausea or vomiting, need for rescue antiemetics, and complete responses in the postoperative period. The complete response was defined as no nausea, no vomiting, and no ant emetic medicationduring a 24-h postoperative period. This was also the primary efficacy end point of the study. The data was analyzed using Pearson’s Chi square test with P &lt; 0.05 taken as significant. Results: Nineteen patients (19%) in the dexamethasone group reported nausea, compared with 43 (43%) in placebo group (p&lt;0.05). Eight patients (8%) in the dexamethasone group reported vomiting and twenty two patients (22%) in theplacebo group reported vomiting (P &lt;0.05). In group I, thirteen patients (13%) asked for rescue anti-emetic where as in group II (placebo group) thirty six patients (36%) asked for rescue anti-emetic (p&lt;0.05). Seventy three patients (73%) in the dexamethasone group showed a complete response, compared with 35 (35%) in placebo group (p&lt;0.05). Conclusion: We concluded that preoperative dexamethasone (8mg) reducesthe incidence of PONV as compared to placebo. As it is a cheap, freely available drug causing no complications, it should be used in otherwise fit selected patients undergoing laparoscopic cholecystctomy.