Preoperative transdermal hyoscine for the prevention of postoperative nausea and vomiting

In a randomised, double-blind study, a transdermal patch containing either hyoscine or placebo was applied post-auricularly in 190 adult patients under 65 year old, seven to twelve hours prior to their undergoing minor orthopaedic or plastic surgery under thiopentone/nitrous oxide/halothane general anaesthesia. In the first 24 hours after surgery 34% of patients vomited. The incidence of nausea (31% vs 54%; P less than 0.01) and the number of episodes of vomiting (66 vs 125; P less than 0.05) during the first 24 hours were significantly less with hyoscine than with placebo. The hyoscine group required fewer doses of antiemetic than the placebo group (12 vs 27; P less than 0.05). Side-effects were mild, the only difference between the two groups being the frequency of dry mouth immediately preoperatively. No differences were seen in the second 24 hours after surgery. We conclude that transdermal hyoscine is moderately effective in reducing the occurrence of postoperative nausea and vomiting following minor surgery.     

The efficacy and cost-effectiveness of prophylactic 5-hydroxytryptamine3 receptor antagonists: tropisetron,ondansetron and dolasetron

There are currently three 5-hydroxytryptamine3 (5-HT3) receptor antagonists available in Australia. In this randomized, double-blind, parallel group study the prophylactic antiemetic effect of a single dose of tropisetron 2 mg, ondansetron 4 mg or dolasetron 12.5 mg was compared after major gynaecological surgery. One hundred and eighteen patients (group T n = 42; group O n = 36; group D n = 40) were evaluated for nausea, vomiting, recovery characteristics and satisfaction for 24 hours postoperatively. A cost-effectiveness analysis was performed. Rescue antiemetic, prochlorperazine 12.5 mg i.m., was given if vomiting occurred more than 10 minutes after arrival in the recovery room. If prochlorperazine was ineffective one hour after administration, droperidol 1 mg i.v. was given. There were no significant differences between groups for the incidence of vomiting during consecutive epochs until 24 hours postoperatively or overall (57%, 75% and 72.5% for groups T, O and D respectively, P = 0.18). The incidence and number of rescue antiementic treatments for nausea or vomiting were similar. The incidence of nausea and the overall and interval nausea scores were similar except for lower "worst nausea" score in group T between 12 and 18 hours (P = 0.02). Recovery times, satisfaction and cost per patient did not differ between groups. We conclude that the risk of postoperative nausea and vomiting remained high in this setting despite 5-HT3 receptor antagonist prophylaxis and that the choice between these agents should be based on the lowest available acquisition cost.     

A randomized, double-blind comparison of ondansetron versus placebo for prevention of nausea and vomiting after infratentorial craniotomy

Ondansetron was compared with placebo for nausea and vomiting prophylaxis after fentanyl/isoflurane/relaxant anesthesia and infratentorial craniotomy. Eight milligrams intravenous ondansetron or vehicle was administered at skin closure. Nausea, emesis, and antiemetic use were recorded at 0, 0.5, 1, 4, 8, 12, 24, and 48 hours. There were no significant intergroup differences for nausea incidence at any interval, but cumulatively the placebo group was 3.2 times more likely to develop nausea during the first 12 hours (P = .04). Nausea incidence was bimodal in both groups, peaking during the first 1 to 4 hours. A nadir occurred at 8 to 12 hours, but nausea increased during the next 36 hours. By 48 hours, approximately 40% of patients in both groups were still nauseated. Reduced vomiting frequency was seen with ondansetron at 4, 8, 12, and 24 hours (P < .05). Despite rescue antiemetics, emesis occurred in an irregular pattern with episodes still observed in 35% of placebo patients at 48 hours. For ondansetron, emesis was infrequent for the first 12 hours but then a persistent increase was observed (48 hours, 22%). The incidence of rescue antiemetic use was 65% for both groups. There was no effect of gender. Nausea and vomiting are frequent and protracted after infratentorial craniotomy. Administration of single-dose ondansetron (8 mg intravenously) at wound closure was partially effective in reducing acute nausea and vomiting but had little delayed benefit. Scheduled prophylactic administration of antiemetic therapy during the first 48 hours after infratentorial craniotomy should be evaluated for efficacy and safety.     

Ondansetron versus metoclopramide in prophylaxis of nausea and vomiting for laparoscopic cholecystectomy: a prospective double-blind randomized study

OBJECTIVE: Patients who undergo laparoscopic cholecystectomy may be at risk of experiencing postoperative nausea and vomiting. This prospective, randomized, double-blind study compared the prophylactic use of metoclopramide and ondansetron for the treatment of postoperative nausea and vomiting in patients who underwent elective laparoscopic cholecystectomy. METHODS: Eighty patients were randomized into two groups. Patients received ondansetron 4 mg or metoclopramide 10 mg intravenously in a double-blind manner at the end of anaesthesia. RESULTS: The incidence of nausea was 45% for metoclopramide and 20% for ondansetron in the 24 hours postoperatively; the difference was statistically insignificant (p = 0.05). Postoperative nausea score did not show any significant difference between the two group in the first 2 hours (p = 0.3) and 4 hours (p = 0.12) but was significant between 4 and 24 hours (p = 0.02). The incidence of vomiting was 20% for metoclopramide and 2.5% for ondansetron. This difference was statistically significant (p = 0.02). CONCLUSION: Ondansetron 4 mg given intravenously at the end of surgery is effective for preventing vomiting after laparoscopic cholecystectomy.     

Use of Anti-Emetics after Intragastric Balloon Placement: Experience with Three Different Drug Treatments

Background: Tropisetron treatment was compared with alizapride treatment. The secondary aim was to assess whether droperidol supplement would still improve the therapeutic outcome of tropisetron. Materials and Methods: A series of 51 obese patients was treated with an intragastric balloon to obtain weight reduction. Patients were divided at random into 3 groups. Each group received a different antiemetic and spasmolytic regimen to control postoperative nausea and vomiting for 24 hours. Statistical analysis of both parameters showed that all 3 populations are comparable and the studied incidence of vomiting was only influenced by the choice of the antiemetics used. A specially developed form was completed during the recovery period every 6 hours until 24 hours postoperatively and recorded all episodes of vomiting. The incidence of vomiting was then calculated as number of episodes/24 hours Results: The incidence of vomiting was significantly lower in the tropisetron group compared to the alizapride group. There was no significant difference between the tropisetron group and the tropisetron plus droperidol group. Conclusion: To decrease the incidence of vomiting in patients undergoing intragastric balloon placement, tropisetron proved to be the most effective antiemetic. A supplement of droperidol gave no better results but impaired postoperative mood and wellbeing. Alizapride was least effective.     

Esomeprazole for the prevention of postoperative nausea and vomiting. A randomized, placebo-controlled trial

BACKGROUND: Postoperative nausea and vomiting still represents a major problem after surgery. Although risk factors for postoperative nausea and vomiting and procedures to reduce postoperative nausea and vomiting have been described, the incidence of postoperative nausea and vomiting remains high. The aim of the present study was to investigate the potential role of the proton pump inhibitor esomeprazole to reduce postoperative nausea and vomiting after elective surgery. METHODS: In a randomized, double-blind trial, ASA I-III patients at high risk for postoperative nausea and vomiting received esomeprazole tablets 3 x 40 mg or matching placebo the evening before surgery, 2 h preoperatively and 24 h postoperatively. Total intravenous anaesthesia with propofol and remifentanil without nitrous oxide (FiO2 0.5) was used. Patients were interviewed using a standardized postoperative nausea and vomiting questionnaire at discharge from the post-anaesthesia care unit, 6 h and 24 h later. The severity of nausea was estimated on a 0-100 point numerical scale (0 = no nausea, 100 = maximum nausea). RESULTS: The incidence of vomiting was similar in the esomeprazole (n = 45) and the placebo (n = 48) groups (64.4% vs. 60.5%, P > 0.05). The average nausea score was 17.8 with esomeprazole and was 18.7 with placebo (P > 0.05). Only 24.7% of all patients (esomeprazole 24.4%, placebo 25.0%) did not experience any nausea or vomiting. CONCLUSION: There is no evidence that prophylactic esomeprazole reduces the incidence of postoperative nausea and vomiting or the degree of postoperative nausea.     

Nitrous oxide does not increase nausea and vomiting following gynaecological laparoscopy

The effect of three different anaesthetic techniques on the incidence and severity of postoperative emesis (nausea, retching and vomiting) was studied in 150 patients undergoing gynaecological laparoscopy. Patients were anaesthetized with isoflurane in nitrous oxide and oxygen (Group A), enflurane in nitrous oxide and oxygen (Group B) or with isoflurane in air and oxygen (Group C). Groups had been predetermined by date of birth. During the first 24 hours after the operation no difference was found at any time in the incidence or severity of emesis among the groups. The overall incidence of emesis during the first 24 hours postoperatively was 54, 48 and 52 per cent, in groups A, B and C, respectively. It is concluded that nitrous oxide does not increase the incidence of emesis after isoflurane anaesthesia and that isoflurane and enflurane anaesthesia are associated with similar incidences of nausea and vomiting after gynaecological laparoscopy.     

Prophylactic use of droperidol for postoperative nausea and vomiting following gynecological laparoscopic surgery under total intravenous anesthesia

BACKGROUND: Propofol and droperidol decrease the incidence of postoperative nausea and vomiting (PONV). We investigated the incidence of PONV after total intravenous anesthesia (TIVA) with propofol alone versus combined use of droperidol and propofol. METHODS: Eighty three patients, who had undergone laparoscopic gynecologic surgery with TIVA using propofol and fentanyl, were retrospectively evaluated whether droperidol had affected the incidence of early (up to six hours postoperatively) and late (6-24 hours postoperatively) PONV. Group D (46 patients) received droperidol intravenously at the end of surgery. Group N (37 patients) received no droperidol. RESULTS: The incidences of early nausea were 27% in Group N and 4% in Group D (P<0.01). The incidences of early vomiting were 0% in Group N and 8% in Group D. The incidences of late nausea were 14% in Group N and 13% in Group D. The incidences of late vomiting were 3% in Group N and 7% in Group D. CONCLUSIONS: Droperidol was useful in reducing the incidence of early nausea and vomiting after total intravenous anesthesia with propofol and fentanyl in the patients undergoing laparoscopic surgery.     

The efficacy of 5-HT3 receptor antagonists for the prevention of postoperative nausea and vomiting after craniotomy: a meta-analysis

The purpose of this meta-analysis was to assess the efficacy of prophylactic administration of 5-HT3 receptor antagonists for postoperative nausea and vomiting in neurosurgical patients at 24 and 48+ hours. After a systematic search, 7 published randomized placebo controlled trials involving 448 craniotomy patients (222 treatment, 226 control) were included in the meta-analysis. Study drugs included ondansetron, granisetron, and tropisetron. The cumulative incidence of emesis was significantly reduced in the treatment group at 24 hours [relative risk (RR)=0.50, 95% confidence interval (CI): 0.38-0.66] and 48+ hours (RR=0.52, 95% CI: 0.36-0.75). There were no differences between the treatment and control groups in the cumulative incidence of nausea at 24 hours (RR=0.76, 95% CI: 0.54-1.06) and 48+ hours (RR=0.81, 95% CI: 0.62-1.06). The cumulative incidence of both nausea and vomiting continued to increase after 24 hours in both groups. Despite the ability of 5-HT3 receptor antagonists to reduce emetic episodes, future investigations should seek to address the control of postoperative nausea and to reduce further postoperative emesis in this population.     

The effect of anaesthetic technique on postoperative nausea and vomiting after day-case gynaecological laparoscopy

Gynaecological surgery is of high emetogenic potential and both total intravenous anaesthesia (TIVA) and prophylactic antiemetic therapy may reduce the incidence of postoperative nausea and vomiting (PONV). We studied 144 patients scheduled for day-case gynaecological laparoscopy in a randomized trial comparing balanced inhalational anaesthesia and prophylactic dolasetron (group I+D) with propofol TIVA and dolasetron (group T+D) or TIVA alone (group T). The primary outcome of "complete response" (no vomiting, no treatment for PONV) was not significantly different among groups (34%, 51%, 32%; groups I+D vs T+D vs T, P=0.12). During the first hour after surgery, group I+D had nausea of greater severity (P<0.03). During hospital admission, group T had more vomiting (P<0.03). From discharge until 24 hours postoperatively, 55% of group I+D experience nausea and 38% vomited. The incidence and severity of nausea were significantly lower in the TIVA groups (P<0.04 and <0.05 respectively). There were no significant differences between groups T+D and T, although comparing all groups the complete response rate was highest and the post-discharge incidence and severity of nausea lowest in group T+D. In conclusion, propofol TIVA, with or without dolasetron, reduced postoperative nausea, but not perioperative vomiting or antiemetic requirement, when compared with inhalational anaesthesia plus dolasetron.     

Intra-articular morphine enhances analgesic efficacy of ropivacaine for knee arthroscopy in ambulatory patients

The aim of this double-blind, randomized control trial was to compare the effectiveness of intra-articular ropivacaine alone or with morphine or ketoprofen for controlling pain after arthroscopic knee surgery. One hundred fifty-six patients scheduled for elective knee arthroscopy were recruited. All patients received general anesthesia and were randomly assigned to 4 groups to receive intra-articular ropivacaine 40 mg (group R), ropivacaine 24 mg plus morphine 8 mg (group R+M), ropivacaine 36 mg plus ketoprofen 100 mg (group R+K), or normal saline (group N/S). Pain, sedation, orientation, nausea, vomiting, and urine retention were recorded at 0, 1, 2, 4, 8, 12, and 24 hours postoperatively. Pain was evaluated by a 10-cm visual analog scale (VAS). When the pain was >2, a suppository of 400 mg paracetamol plus 10 mg codeine plus 50 mg caffeine was given. Results showed that at 4 hours postoperatively, pain differed significantly among the 4 groups (P<.001), with less pain recorded in the R+M group. Similarly, the number of suppositories administered postoperatively to the R+M group was significantly less (P<.001) vs the other groups. Patients who received ropivacaine and morphine or normal saline had a higher incidence of nausea and vomiting vs the other groups (P=.001 and P=.036, respectively). The combination of intra-articular ropivacaine and morphine is associated with less pain after knee arthroscopy during early recovery but with a higher incidence of nausea and vomiting. However, the addition of ketoprofen to ropivacaine provides relatively satisfactory pain relief, but with fewer side effects compared to morphine.     

Prevention of postoperative nausea and vomiting after intrathecal morphine for Cesarean section: a randomized comparison of dexamethasone, droperidol, and a combination

BACKGROUND: Intrathecal morphine provides good analgesia after cesarean delivery but the side effects include nausea and vomiting. Low-dose droperidol (0.625 mg) combined with dexamethasone 4 mg is postulated to have an additive antiemetic effect with less side effects. We therefore compared single doses of dexamethasone and droperidol alone with a low-dose combination of the two, to prevent spinal morphine-induced nausea and vomiting after cesarean section. METHODS: In a double-blind study, 120 women undergoing elective cesarean section under spinal anesthesia (using 0.5% bupivacaine 10 mg and morphine 0.2 mg) were allocated randomly to receive dexamethasone 8 mg, droperidol 1.25 mg, dexamethasone 4 mg and droperidol 0.625 mg, or placebo, before the end of surgery. The incidences of nausea and vomiting, sedative score, pain score, and side effects were recorded. RESULTS: The incidence of nausea and vomiting within 6 h postoperatively was lower and incidence of no nausea and vomiting for 24 h postoperatively was significantly higher for the combination group compared to the placebo group and the dexamethasone only group. Sedation scores within 3 h postoperatively and incidence of restlessness for the combination group were significantly lower than in the droperidol only group. CONCLUSION: An additive antiemetic effect and no significant side effects were shown for the combination of dexamethasone 4 mg and droperidol 0.625 mg. This combination was more effective than either dexamethasone 8 mg or droperidol 1.25 mg alone in preventing nausea and vomiting after spinal anesthesia using 0.5% bupivacaine and morphine 0.2 mg.     

Efficacy and adverse effects of prophylactic antiemetics during patient-controlled analgesia therapy: a quantitative systematic review.

Nausea and vomiting are frequent adverse effects of patient-controlled analgesia (PCA) with opioids. To identify the optimal prophylactic antiemetic intervention in this setting, we performed a systematic search for randomized trials (MEDLINE, EMBASE, Cochrane library, reference lists, hand-searching, no language restriction) published up to May 1998 that compared prophylactic antiemetic interventions with placebo or no treatment in the postoperative PCA-setting with opioids. Fourteen placebo-controlled trials (1117 patients) with different regimens of droperidol, ondansetron, hyoscine TTS, tropisetron, metoclopramide, propofol, and promethazine were analyzed. One PCA was with tramadol, all others were with morphine. At 24 h, the cumulative incidence of nausea and vomiting without antiemetics was approximately 50%. Droperidol 0.017-0.17 mg/mg of morphine (0.5-11 mg/d droperidol) was statistically significantly more effective than placebo without evidence of dose-responsiveness; the number needed to treat to prevent nausea compared with placebo was 2.7 (95% confidence interval 1.8-5.2), and that to prevent vomiting was 3.1 (2.3-4.8). Compared with placebo, the incidence of minor adverse effects with droperidol was increased with doses >4 mg/d. IMPLICATIONS: Of 100 patients treated with droperidol added in a patient-controlled analgesia pump with morphine, 30 who would have vomited or been nauseated had they not received droperidol will not suffer these effects. There is no evidence of dose-responsiveness for efficacy with droperidol, but the risk of adverse effects is dose-dependent. There is a lack of evidence for other antiemetics.     

Efficacy of Ultrasound-Guided Quadratus Lumborum Block for Postoperative Analgesia After Hip Arthroplasty: A Meta-Analysis of Randomized Controlled Trials

BackgroundUltrasound-guided quadratus lumborum (QL) block as a novel regional anesthetic technique was proposed in 2007 that can be applied in patients following hip arthroplasty. This study aimed to evaluate the efficacy of the QL block for pain control in patients undergoing hip arthroplasty.MethodsWe performed a comprehensive search of PubMed, Web of Science, Scopus, Cochrane Library, Embase databases, Google Scholar, and CNKI for randomized controlled trials up to December 2021. According to the inclusion and exclusion criteria established in advance, “QL block” and “hip arthroplasty” related MeSH terms and free-text words were used.ResultsOur meta-analysis included 11 randomized controlled trials involving a total of 830 patients between 2018 and 2021. The results indicated that compared to the non-QL block group, Visual Analog Scale (VAS) score at mobilization in the QL block group demonstrated statistical and clinical significance at all time points (12, 24, and 48 hours), but VAS score at rest failed to reach the MCID (minimal clinically important difference). Meanwhile, opioid consumption in the QL block group only demonstrated statistical and clinical significance at 48 hours postoperatively, but did not reach the MCID at 12 or 24 hours postoperatively. The QL block increased satisfaction scores. There was a statistically significant reduction in the incidence of postoperative nausea and vomiting, but no difference in the incidence of pruritus and urinary retention.ConclusionThe QL block significantly reduced postoperative VAS score at mobilization, and opioid consumption at 48 hours in patients after hip arthroplasty compared to no block, which reached the MCID. The QL block also decreased postoperative nausea and vomiting and increased satisfaction scores. Although these are promising results, the clinical relevance of the efficacy of the QL block remains to be further understood as larger studies are needed.     

手术中高浓度吸氧不能降低椎管内麻醉下剖宫产患者手术后恶心呕吐的发生率和严重程度

背景高浓度吸氧可能降低全麻后恶心、呕吐的发生率。本研究旨在评估手术中给氧能否降低椎管内麻醉剖宫产手术后产妇恶心、呕吐的发生率。方法本研究为前瞻性随机双盲研究，对行剖宫产的产妇采用标准椎管内麻醉和手术后镇痛。夹闭脐带后，将产妇随机分为两组，分别吸入浓度为70％或21％的氧气。分别在3个时间段记录恶心、呕吐情况：麻醉开始到胎儿娩出、胎儿娩出到手术结束及手术后24小时。使用χ^2检验和配对t检验判断是否存在显著性差异。结果各组患者人口学特征和手术情况相似。各组间总的恶心、呕吐发生率差异没有显著性。吸氧组在胎儿娩出前、胎儿娩出后、手术后重度恶心的发生率（由产妇评价）分别为3％、7％、9％，而医用空气组分别为3％、9％、7％；在上述各时间段，吸氧组和医用空气组重度呕吐（超过2次）发生率均分别为0％、2％、4％。两组间差异没有显著性。结论手术中吸入高浓度氧不能降低椎管内麻醉剖宫产产妇手术中、手术后恶心、呕吐的发生率及严重程度。     

Morphine-sparing effect of ketoprofen after abdominal surgery

In a double-blind, placebo-controlled clinical trial (power of 80% to detect a 30% reduction in morphine consumption, P < 0.05), we have determined that the administration of two doses of intravenous ketoprofen 100 mg, one at the end of surgery and the second 12 hours postoperatively, was associated with a significant reduction in morphine consumption at eight (P = 0.028), 12 (P = 0.013) and 24 hours (P = 0.013) but not four hours (P = 0.065) postoperatively, as compared to placebo, when assessed by patient-controlled analgesia. There was no difference between the groups in pain scores or in the incidence of nausea and vomiting. One patient in the placebo group suffered from excessive sedation while one patient from the ketoprofen group suffered from transient oliguric renal failure. There were no other adverse effects. The results of this study show that ketoprofen does provide a morphine-sparing effect in the management of postoperative pain after abdominal surgery.     

Does etomidate increase postoperative nausea? A double-blind controlled comparison of etomidate in lipid emulsion with propofol for balanced anaesthesia

In a double-blind randomized study, the incidence and severity of postoperative nausea and vomiting was investigated with a new formulation of etomidate (Etomidate-(R)Lipuro, B. Braun Melsungen AG, Germany) compared with propofol for induction of a balanced anaesthesia with isoflurane/fentanyl in air. The incidence and intensity of nausea was examined by use of a visual analogue scale (VAS; 0-100 mm) at 1, 2, between 6 and 8, and 24 h postoperatively. One-hundred-and-sixty-four patients undergoing orthopedic procedures were studied. For etomidate vs. propofol, 14.6% vs. 14.2% male and 26.8% vs. 27.5% female patients were nauseated during the first two postoperative hours. The median rating for nausea remained below 5 mm at any time in both groups, i.e. the intensity of nausea was very low. The incidence of vomiting was higher in women receiving etomidate (26.8% vs. 10%). We conclude that etomidate does not increase nausea during the early postoperative period.     

A comparison of epidural and intramuscular morphine in patients following cesarean section

This randomized, double-blind study compared epidural (EP) and intramuscular (IM) morphine in 24 healthy parturients for 24 h after cesarean section. The 11 EP subjects received 5 mg of EP morphine and normal saline intramuscularly, and the 13 IM patients received 5 mg of IM morphine and normal saline epidurally. Both injections were given simultaneously just after delivery and then upon request with at least 30 min between each pair of injections. Blood pressure, visual analogue scale pain score, somnolence score, and presence of nausea, vomiting, or pruritus were assessed every 30 min for 1 h after each dose and then hourly. Oxyhemoglobin saturation (Spo2) and respiratory rate (RR) and pattern were monitored continuously with pulse oximetry and respiratory inductive plethysmography. The EP group had significantly lower pain scores (less pain) than the IM (0.9 +/- 0.3 vs. 3.3 +/- 1.3; mean +/- SD; P less than 0.001) with less morphine (0.3 +/- 0.2 vs. 2.2 +/- 0.6 mg patient-1 h-1; P less than 0.001). There was no difference between groups for RR, Spo2, incidence or frequency of slow respiratory rate (SRR, 5-min mean RR less than 10) and apneas (AP, greater than or equal to 15 s of less than 100 ml tidal volume), incidence of nausea and/or vomiting, pruritus, or hypotension, and hours asleep or drowsy. There were no major respiratory abnormalities. During control monitoring of nine EP and 11 IM subjects while asleep postoperatively, the RR, Spo2, and incidence and frequency of SRR and AP were similar to the study period in both groups. In conclusion, EP morphine was a more effective analgesic than IM morphine, but the side effects of both were similar.     

枢复宁预防全麻腹部手术后恶心和呕吐的临床研究

全麻患者术后常易发生恶心、呕吐，枢复宁有抗呕吐作用。随机选择１００例腹部外科手术患者，分为枢复宁组（４ｍｇ，ｎ＝５０）和安慰剂组（生理盐水，ｎ＝５０），诱导前静注枢复宁或安慰剂，注速１分钟，双盲法观察术后２４小时抗恶心、呕吐效果及副作用。结果表明，用药组恶心、呕吐发生率（１８％，０）明显低于安慰剂组（５０％，４０％）（Ｐ＜０．０１），两组患者的平均动脉压、经皮血氧饱和度，呼吸频率和心率，血液成分，肝、肾功能无明显改变。因此，枢复宁适用于腹部外科患者术后恶心、呕吐的防治。     

Anticholinergics improve fibreoptic intubating conditions during general anaesthesia

Purpose

To determine if anticholinergic agents improve fibreoptic intubating conditions and to compare the efficacy and side effects of glycopyrrolate and hyoscine.

Methods

Eighty ASA I adults undergoing elective wisdom tooth extraction were randomly allocated to receive 0.4 mg hyoscine hydrobromide po, 0.4 mg hyoscine hydrobromide im, 0.4 mg glycopyrrolate im or no anticholinergic, one hour pre-operatively. All underwent nasal fibreoptic intubation under general anaesthesia. The time taken to pass the fibreoptic scope was noted and visual analogue scores (VAS) were recorded for clarity of visual field and post-operative sore throat, dry mouth and nausea.

Results

The time to intubation was not different among the four groups (Kruschal-Wallis P=0.07). The clanty of visual field was improved in all three anticholinergic groups (Kruschal-Wallis P=0.006), but there was no difference among the three groups (median VAS control 6.4, glycopyrrolate 8.0, oral hyoscine 7.9, im hyoscine 7.7). There was no difference in post-operative side effects among any of the groups at both 30 mm and four hours.

Conclusion

The addition of an anticholinergic produced better visual conditions for intubation but had no effect on the incidence of post-operative sore throat, dry mouth and nausea.