Vomiting In Laparoscopic Cholecystectomy Research Articles

Efficacy of dexamethasone in prevention of postoperative nausea and vomiting in laparoscopic cholecystectomy.

Objective: To evaluate the efficacy of intravenous dexamethasone in comparison with control group for the prevention of po3stoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy. Study Design: Randomized controlled study. Setting: Department of Surgery, Dr. Akbar Niazi Teaching Hospital, Islamabad, Pakistan. Period: 1st November 2022 to 31st April 2023. Material & Methods: A total of 120 patients of prospective laparoscopic cholecystectomy from both genders in ages between 18-60 years were randomized into two equal groups A and B. Group A subjects were administered with 4 mg IV dexamethasone preoperatively while group B patients were control subjects. The primary outcome was set as the reduced PONV after surgery. It was assessed through VAS scores and recorded at different time intervals. The final outcome was measured at 24th hour. Rescue antiemetic was administered whenever VAS score became > 5. Results: At 24 hours after surgery, VAS score was 0.57 ± 1.42 SD in group A and in group B it was 1.67 ± 2.10 SD (p=0.001). Efficacy of treatment (no PONV up to 24 hours) was present in 81.7% patients in group A (dexamethasone) and in 56.7% of patients in group B (control). The difference was statistically significant (P=0.003). Conclusion: Preoperative intravenous administration of dexamethasone was found effective in controlling PONV in patients undergoing laparoscopic cholecystectomy. Moreover, prophylactic dexamethasone administration also resulted in lesser consumption of rescue antiemetics when compared with controlled group.

Preoperative pregabalin to prevent postoperative nausea and vomiting in laparoscopic cholecystectomy

Background. Postoperative laparoscopic cholecystectomy period is often associated with nausea and vomiting, which is stopped by an antiemetics injected intravenously. Meanwhile, it is known that the oral pregabalin before surgery to potentiate the effect of opioids and nonsteroidal anti-inflammatory medications during anesthesia also has an antiemetic effect.The objective was to evaluate the effect of oral pregabalin to reduce the frequency of postoperative nausea and vomiting in laparoscopic cholecystectomy cases.Methods and Materials. Randomized double blind study. One hundred patients of the American Society of Anesthesiology (ASA) class1 were tested and divided into two groups. The first group did not receive any antiemetics preoperatively. The second group received 75 mg of oral pregabalin 30 minutes before anesthesia. We followed up patients postoperatively in the recovery room and general surgical ward for 24 hours, recorded the incidence of nausea and vomiting, prescription of any antiemetics and developing their side effects. We assessed the risk of developing the incidence of postoperative nausea and vomiting by the use of the Koivuranta score.Results. Statistical analysis using SPSS showed a significant reduction of postoperative nausea and vomiting in the second group (pregabalin) compared with the first group.Conclusion. Preoperative 75 mg of oral pregabalin has antiemetic effect on postoperative time. No significant postoperative side effects were noted.

Postoperative Nausea and Vomiting in Opioid-Free Anesthesia Versus Opioid Based Anesthesia in Laparoscopic Cholecystectomy.

Background: Postoperative nausea and vomiting (PONV) is a usual complication in patients undergoing laparoscopic cholecystectomy. Minimized opioid use due to surgery has been shown to have a better effect on patient recovery after surgery. In this study we evaluate the effect of opioid free anesthesia for postoperative nausea and vomiting in laparoscopic cholecystectomy. Materials and methods: 80 patients aged 20-65 years old were included in this randomized, clinical and prospective trial. The patients belonged to the ASA classifications 1 and 2 and were scheduled for laparoscopic cholecystectomy. Patients were classified into two groups: group 1 (fentanyl group- FG), which included 40 patients who received opioid anesthesia, and group 2 (opioid free anesthesia group-OFAG) which included 40 patients who received opioid free anesthesia. In patients from group 1 (fentanyl group -FG) introduction to general anesthesia consisted of giving midazolam at 0.04 mg/kg, fentanyl at 0.002 mg/kg, 2 mg/kg of propofol and 0.6 mg/kg of rocuronium bromide. These patients received fractionated bolus doses of fentanyl during surgery. Prior to general anesthesia these patients did not receive dexamethasone. The patients from group 2 (opioid free anesthesia group - OFAG) received dexamethasone at 0.1 mg/kg and 1 g of paracetamol before introduction to anesthesia as a pre-emptive analgesia. Introduction to anesthesia consisted of giving midazolam at 0.04 mg/kg, lidocaine at 1 mg/kg, propofol at 2 mg/kg, ketamine at 0.5 mg/kg, and 0.6 mg/kg of rocuronium bromide. Immediately after intubation, continuous intravenous infusion with lidocaine at 2 mg/kg/h and magnesium sulfate at 1.5 g/h was given. In this group, fentanyl was not given either during the introduction of anesthesia or during the intraoperative period. Immediately after extraction of the gallbladder patients from group 2 (OFAG) received 2.5 g of metamizole intravenously. PONV were recorded in the postoperative period of 24 hours after surgery. Results: There was no significant difference with respect to age, weight, sex, duration of surgery, and anesthesia time. PONV at different time intervals were statistically not significant at all postoperative time points - 1 hr, 4 hr, 8 hr, 12 hr and 24 hr after surgery in fentanyl group compared to opioid free anesthesia group. Even not statistically significant, PONV have occurred more often in patients who received opioid anesthesia. Conclusion: Postoperative nausea and vomiting occurs more often in patients who received opioids during laparoscopic cholecystectomy compared to patients who received opioid free anesthesia, but without statistical significance.

Effectiveness of dexamethasone and ondansetron in postoperative nausea and vomiting in laparoscopy cholecystectomy.

Objective: To determine the effectiveness of combination of dexamethasone and ondansetron in prevention of postoperative nausea and vomiting in laparoscopic cholecystectomy. Study Design: Descriptive Case Series study. Setting: Departments of Surgery, Khyber Teaching Hospital and Hayatabad Medical Complex, Peshawar. Period: 01 Jan 2018 to 31 May 2019. Material & Methods: A total of 231 patients undergoing laparoscopic cholecystectomies were included in the study and subjected to dexamethasone in combination with ondansetron and followed up at 24 hours after surgery to detect nausea and vomiting. Results: The mean age of the study sample was 38.5 + 10.4 years. In our study, we had 62.3% males and 37.7% female patients. On follow up, we observed that PONV was recorded in 39.4% of patients of which grade 1 were 15.2%, grade 2 were 14.7% and grade 3 were 9.5%. In this regards, the effectiveness of dexamethasone and Ondansetron combination was recorded in 60.6% of patients. Conclusion: The combination of dexamethasone and ondansetron is moderately effective in prevention of post operative nausea and vomiting.

Is Multimodal Anesthesia Effecting Postoperative Nausea and Vomiting in Laparoscopic Cholecystectomy?

Background: Multimodal anesthesia represents a technique that can improve analgesia and lower the occurrence of opioid side effects in the postoperative period, such as postoperative nausea and vomiting (PONV). It can be achieved by providing different types of medication during the intraoperative period which can decrease the need for opioids. PONV happens more often in patients who have received large amounts of opioids during laparoscopic cholecystectomy. In this study, our aim was to observe the occurrence of PONV between three different groups of patients who received lidocaine, ketamine and magnesium sulfate in combination with fentanyl in the intraoperative period. We also observed any additional nausea and vomiting in the three groups as well as the amount of fentanyl given to these groups during operation. Materials and methods: 120 patients aged 20-65 years old were included in this randomized and prospective study, ASA classification 1 and 2, scheduled for laparoscopic cholecystectomy. Patients were classified into three groups randomly: Group 1 (lidocaine group-LG), these patients received lidocaine at 1 mg/kg during induction to general anesthesia and 2 mg/kg/h after intubation in continuous intravenous infusion; Group 2 (ketamine group-KG) these patients received ketamine at 0.5 mg/kg during induction to general anesthesia; and Group 3 (magnesium group-MG) these patients received magnesium sulfate at 1.5 gr/hr as a continuous intravenous infusion after intubation. In all three groups, patients additionally received bolus doses of fentanyl. Postoperative nausea and vomiting were monitored in all three groups at 1, 4, 8, 12, and 24 hours after surgery as a primary objective, and if patients had complainant of vomiting, they were treated with 10 mg of metoclopramid. Between the five control time points, additional nausea and vomiting was recorded as well, as a secondary objective. The third objective was to measure of the total amount of fentanyl given in the intraoperative period. Results: Patients from the lidocaine group experienced less PONV and they received less fentanyl compared to patients of ketamine and magnesium groups. Patients from the ketamine group had more nausea than other groups. In the magnesium group, the rate of vomiting was higher, and they received higher amounts of fentanyl during surgery. Additional nausea and vomiting occurred in 3 patients in the LG, 2 in the KG, and 3 in the MG between the five control time points. The patients from the magnesium group received the highest dose of fentanyl during surgery (307.50 ± 130.4), followed by the patients from the ketamine group (292.50 ± 60.5), and then patients from the lidocaine group (258.75 ± 60.9). The doses of fentanyl that patients received during surgery in all three groups were not statistically significant. Conclusion: Multimodal anesthesia has been shown to lower PONV 24 hours after laparoscopic cholecystectomy and can lower need for opioids during laparoscopic cholecystectomy.

Effect of the Timing of Acupressure Application to P6 on Postoperative Nausea and Vomiting in Laparoscopic Cholecystectomy

Effect of the Timing of Acupressure Application to P6 on Postoperative Nausea and Vomiting in Laparoscopic Cholecystectomy

Comparative Study of Ondansetron and Granisetron for Preventing Post-Operative Nausea and Vomiting in Laparoscopic Cholecystectomy under General Anaesthesia

Introduction
 Post-operative nausea and vomiting are commonly experienced unpleasant complications of general anesthesia following laparoscopic surgeries. The study was undertaken to compare the antiemetic efficacy of two different 5-hydroxytryptamine-3 receptor antagonists, ondansetron and granisetron when given prophylactically to patients undergoing laparoscopic cholecystectomy under general anesthesia.
 Methods
 A prospective, double-blind study, was conducted in 60 patients aged 20-60 years ASA-PS I/II, weighing 40-80 kgs, undergoing elective laparoscopic cholecystectomy under general anesthesia. Patients were divided into two groups: Group A (Ondansetron 4mg intravenously) and Group B (Granisetron 2mg intravenously) with 30 patients in each group. Both the drugs were diluted in normal saline to 10 ml and were given at the end of surgery before the reversal of the neuromuscular blockade. Episodes of nausea and vomiting were assessed at 6, 12, and 24 hours post-operatively. Collected data was applied with the appropriate test in Statistical Package for the Social Sciences (SPSS) and p-value <0.05 was considered significant.
 Results
 Incidence of PONV was greater in Ondansetron group (53.33%) compared to Granisetron group (23.33%) (p=0.02). Demographic data were comparable in both groups (p>0.05). The episodes of retching and vomiting at different intervals were found to be higher in the ondansetron group. However, it was statistically insignificant. The use of rescue anti-emetics was greater in group A (13.33%) compared to group B (3.33%) but the finding was insignificant statistically (p=0.16).
 Conclusion
 The incidence of PONV was significantly high in the Ondansetron group than in the Granisetron group when given prophylactically in laparoscopic cholecystectomy.

Effect of Anti-Emetic Combination of Sevoflurane / Propofol Anesthesia Technique in Laparoscopic Cholecystectomy

Objective: To assess symptoms of nausea and vomiting in laparoscopic cholecystectomy post-operatively, administered anesthesia by sevoflurane or propofol and to assess the effect of dexamethasone and ondansetron anti-emetic combination. Study design & Setting: It was an experimental study design conducted from 08-Oct-2017 till 11-Jul-2018 at Rawal General & Dental Hospital. Methodology: Patients were recruited in interventional groups by lottery method as n=160, with 80 cases allocated in each group. The patients with gallstones planned for laparoscopic cholecystectomy after preoperative assessment were classified to American Society of Anesthesiologist (ASA) physical status class I-II. All the patients placed in a particular ASA physical status class were (exposed to both induction methods) either anesthetic induction by propofol 1-2 mg/kg (group-A) or by employing sevoflurane 4-8% (group-B) in combination with oxygen, while maintenance was done in both study groups with 2% sevoflurane and 50% nitrous oxide in oxygen. After procedure patients stayed in post-anesthesia care unit where intra-operative monitoring was evaluated. The primary end point of the study was to note the rate of nausea and vomiting in 24 hours interval after surgery. Results: Both sevoflurane and propofol are equally effective anesthetic induction agents. The same combination of dexamethasone and ondansetron was given to both groups and so the actual effect of both anesthesia drugs in terms of side effects were nullified. Conclusion: In laparoscopic cholecystectomy, both sevoflurane and propofol are good enough when administered with dexamethasone and ondansetron anti-emetic combination, for post-operative nausea and vomiting up to 24 hours observation time in study.

Prevention of Post-operative Nausea and Vomiting in Laparoscopic Cholecystectomy: A Comparison of Metoclopramide and Ondansetron

Prevention of Post-operative Nausea and Vomiting in Laparoscopic Cholecystectomy: A Comparison of Metoclopramide and Ondansetron

Granisetron and Ondansetron on Post Operative Nausea and Vomiting in Laparoscopic Cholecystectomy Under General Anesthesia At Bir Hospital Kathmandu, Nepal

IntroductionLaparoscopic cholecystectomy has higher incidence of postoperative nausea and vomiting (PONV). In routine practice single dose of drug is given prophylactically during the surgery.ObjectiveThis study aimed to compare the antiemetic efficacy of two different 5-hydroxytryptamine-3 (5HT3) receptor antagonists, Ondansetron and Granisetron when given prophylactically to patients undergoing laparoscopic cholecystectomy.MethodologyIt was a randomized, single blind study, conducted in 75 patients undergoing laparoscopic cholecystectomy. Patients were divided into two groups: Group O and Group G. Patients in group O were given 0.1 mg/kg Ondansetron intravenously (IV) and patients in Group G were given 0.04 mg/kg Granisetron. The standard general anesthetic technique was administered to all the patients. Episodes of nausea, retching and vomiting were assessed during the first 24 hours after anesthesia. Collected data was applied with appropriate test in SPSS 16 and overall significance level was considered at 95% confidence interval (p ≤ 0.05).ResultsThere was no statistically significant difference for demographic data among the two groups (P>0.05). Both drugs were similarly effective in first four hours (P>0.05). Between 4–12 hours and 12-24 hours, episodes of nausea and vomiting were higher in Ondansetron group.ConclusionThe incidence of PONV was significantly high in Ondansetron than in Granisetron given prophylactically in laparoscopic cholecystectomy. Birat Journal of Health SciencesVol.2/No.1/Issue 2/ Jan - April 2017, page: 175-178

The effect of low dose midazolam in addition to ondansetron on post-operative nausea and vomiting in laparoscopic cholecystectomy – a comparative study

Background Nausea, retching and vomiting are among the most common postoperative complaints. Premedication with low dose midazolam in addition to ondansetron is more effective in controlling postoperative nausea and vomiting. Objectives This study was designed to observe the effect of low dose midazolam 7.5mg in addition to ondansetron 4mg on postoperative nausea and vomiting in laparoscopic cholecystectomy. Methods 100 patients of ASA grade I and II, age range 30-50 years and weight 50-70 kg were randomly selected by a blind envelop method. They were equally divided into four groups of 25 patients in group each. Group I received vitamin, Group II ondansetron 8mg, Group III ondansetron 8mg and midazolam 7.5mg and Group IV ondansetron 4mg and midazolam 7.5 mg orally one hour before operation. In the recovery room occurrence of nausea and vomiting was assessed for 24 hours. Results The incidence of nausea was in vitamin Group I 64%, in ond8 group II 32%, in ond8+mid7.5 group III 24% and in ond4+mid7.5 group IV 24%. The incidence among the groups was highly significant (p=0.008). The incidence of vomiting was in vitamin Group I 16%, in ond8 group II 16%, in ond8+mid7.5 group III 8% and in ond4+mid7.5 group IV 8%. The difference among the groups were not significant (p=0.808). Conclusion Low dose midazolam 7.5mg in addition to ondansetron 4mg is more effective in controlling postoperative nausea and vomiting in laparoscopic cholecystectomy. DOI: http://dx.doi.org/10.3329/jbsa.v24i1.19793 Journal of Bangladesh Society of Anaesthesiologists 2011; 24(1): 8-12

Randomised Study of effectiveness of Dexamethasone in Reducing Post-operative Nausea and Vomiting in Laparoscopic Cholecystectomy

Randomised Study of effectiveness of Dexamethasone in Reducing Post-operative Nausea and Vomiting in Laparoscopic Cholecystectomy

Anti-Emetic Doses of Dexamethasone Suppress Cortisol Response in Laparoscopic Cholecystectomy

The efficacy of dexamethasone alone or in combination with a serotonergic antagonist to prevent nausea and vomiting in laparoscopic cholecystectomy is well established, but few data exist regarding its effects on perioperative cortisol and glucose levels. Fourteen non-diabetic subjects having elective laparoscopic choleycystectomy and standardised general anaesthesia were randomised to receive 8 mg of intravenous dexamethasone and tropisetron or tropisetron alone. Plasma cortisol and glucose were measured preinduction, at five and 24 hours postoperatively. There was no difference in plasma cortisol at five hours postoperatively in patients who received dexamethasone, but by 24 hours there was marked suppression compared to the control group (P < 0.005) to less than 5% of the preoperative value. There was a small but statistically significant elevation in blood glucose at 24 hours (P < 0.01) in the dexamethasone-treated group. In patients undergoing laparoscopic cholecystectomy, an anti-emetic dose of dexamethasone (8 mg) markedly suppresses plasma cortisol at 24 hours and causes a minor elevation in blood glucose.

Low dose of droperidol in confronting postoperative nausea and vomiting in laparoscopic cholecystectomy: A clinical trial

Low dose of droperidol in confronting postoperative nausea and vomiting in laparoscopic cholecystectomy: A clinical trial

Effects of Remifentanil and Fentanyl on Postoperative Nausea and Vomiting in Laparoscopic Cholecystectomy with using Propofol

Background: Opioids can produce postoperative nausea and vomiting (PONV). Remifentanil is a nonaccumulative ultra short-acting opioid because of its rapid systemic elimination. This rapid systemic elimination could contribute to a faster weaning from the opioid side-effects like PONV. This study compared remifentanil and fentanyl with regards to the frequency of PONV in laparoscopic cholecystectomy with using propofol. Methods: Sixty ASA physical status I or II patients who were scheduled for laparoscopic cholecystectomy were randomly assigned to either the remifentanil group (n = 30) or the fentanyl group (n = 30). Anesthesia was induced with propofol, rocuronium and remifentanil (n = 30, 1/kg) or fentanyl (n = 30, 2/kg). After tracheal intubation, anesthesia was maintained with propofol, oxygen/air and infusion of opioid (only for remifentanil group 0.2-0.5/kg/min). Postoperatively (1 hr, 12 hr, and 24 hr), we recorded the visual analogue scale (VAS), the rescue meperidine consumption, the number of patients with episodes of PONV and the number of ondansetron injection. Results: The number of PONV episodes were significantly higher in the fentanyl group at the 1-12 hr postoperative period (p ＜ 0.05; n = 8 vs. n = 1, fentanyl and remifentanil, respectively). However, the incidence of PONV at 0-1 hr and 12-24 hr and the total incidence of PONV were not different between the two groups. Conclusions: The use of ultra-short acting remifentanil instead of fentanyl can reduce PONV at 1-12 postoperative hours in the laparoscopic cholecystectomy patients.

Comparison of low and standard pressure gas injection at abdominal cavity on postoperative nausea and vomiting in laparoscopic cholecystectomy.

Background and Objective: Postoperative nausea and vomiting (PONV) is the main concern for 40-70% of patients undergoing laparoscopic cholecystectomy. Our objective was to compare carbon dioxide gas at low pressure and standard pressure for the occurrence of PONV on patients undergoing laparoscopic cholecystectomy. Methods: This double- blind trial was conducted on 50 women patients aged between 18 to 60 years with acute cholecystectomy. The patients were divided into two groups: low pressure (LP) (received LP gas, 7-9 mmHg) and standard pressure (SP) (received SP gas, 14-15 mmHg). Nausea and vomiting in patients at hours 0-4, 4-8, 8-12, 12-24 after the surgery were recorded. Results: The frequency of PONV in the LP and SP groups did not demonstrate statistically significant different (P > 0.05). Nevertheless the frequency of shoulder pain after 4 hours at the LP group compared with SP group was significantly different (P < 0.023). Conclusions: The use of low pressure gas compared to standard pressure gas to create pneumoperitoneum could not reduce the PONV whereas the frequency of shoulder pain in LP group was reduced. Low pressure gas was associated with reduction of surgeon visibility and subsequently more prolonged surgery duration.