Postoperative nausea and vomiting. A comparison between intravenous and inhalation anaesthesia in breast surgery

Nausea and vomiting during the first 24 postoperative hours after breast surgery were studied. Ninety patients scheduled for elective breast surgery were randomly assigned to one of three anaesthetic methods: total intravenous anaesthesia with propofol, or propofol or thiopental for induction followed by isoflurane anaesthesia. All three groups received fentanyl for peroperative analgesia. A total of 46 (51%) patients experienced emetic sequelae: 19 (21%) complained about nausea and another 27 (30%) vomited once or more during the postoperative course. More than 50% of the patients with nausea and 70% with vomiting first suffered from these symptoms in the surgical wards after leaving the postoperative unit. Nausea and vomiting were seen in 18 (60%), 13 (43%) and 15 (50%) for the groups propofol–propofol, propofol–isoflurane and thiopental–isoflurane, respectively. In conclusion, every second patient experienced nausea or vomiting after breast surgery, the majority of these emetic symptoms occurring after leaving the postoperative unit. Propofol for induction or as a main anaesthetic did not make any major difference with regard to postoperative nausea or vomiting.     

Studies in postoperative sequelae. Nausea and vomiting—still a problem

We collected data on postoperative nausea and vomiting from 3850 patients aged 11–91 years. Thirty-seven percent of the 3244 patients who received a general anaesthetic reported nausea and 23.2% vomited. Twenty percent of the 606 patients who received a local anaesthetic reported nausea and 11.4% vomited. Of the general anaesthetic patients reporting nausea, 72.2% were women, and the mean age was lower than for those who did not (p < 0.001). Similarly for vomiting, 74.0% were women and again the mean age was lower (p < 0.001). Of the local anaesthetic patients reporting nausea, 62.0% were women and the mean age was lower than for those who did not (p < 0.001). Similarly for vomiting, 68.1% were women and again the mean age was lower (p < 0.001). Anxiety before general, but not local, anaesthesia was associated with postoperative nausea (p < 0.001) but not vomiting. Patients from the gynaecological, orthopaedic, ENT and general surgical wards had higher incidences of postoperative nausea and vomiting. Linear visual analogue pain scores were higher in patients with postoperative nausea and vomiting in both general and local anaesthesia groups (p < 0.001).     

Premedication with promethazine and transdermal scopolamine reduces the incidence of nausea and vomiting after intrathecal morphine

Intrathecal morphine provides effective postoperative pain relief in major orthopaedic surgery. Its use, however, is associated with unpleasant side effects like nausea and vomiting. The effect of different premedications on postoperative emetic sequelae induced by intrathecal morphine was studied in a prospective, double blind study. Sixty patients scheduled for arthroplasty surgery of the lower extremity were anaesthetized with spinal anaesthesia with a combination of isobaric bupivacaine 20 mg and morphine 0.3 mg. For premedication the patients were randomised to three groups of equal size. They received either oral diazepam (5 15 mg), oral promethazine (10 mg) or a combination of promethazine and transdermal scopolamine (1.5 mg).
Sixty percent of the patients with both promethazine and transdermal scopolamine were totally free from postoperative nausea and vomiting (PONV) symptoms compared to those premedicated with diazepam (40%) or promethazine alone (30%). Promethazine together with transdermal scopolamine reduced significantly the number of patients with vomiting (to 25%) and also vomiting episodes. This combination was also more efficient in reducing the incidence of nausea (to 25%) and nausea episodes than promethazine alone ( P <0.05). Combination also reduced the requests for additional pain relief ( P <0.05). PONV occurred in a majority of patients during the first 12 hours of the 24 hour study period and the need for additional analgesics thereafter. The incidence of itching (50–65%) and urinary catheterisation (55–70%) was similar in all groups.
In conclusion, the combination of oral promethazine and transdermal scopolamine was most effective in reducing PONV symptoms and also reduced the need for postoperative pain treatment.     

Surgeon's experience as a factor for emetic sequelae after middle ear surgery

Purpose: To test the hypothesis that an experienced surgeon is associated with less postoperative nausea and vomiting (PONV).
Methods: A post hoc analysis was done on the data of 167 patients from 3 randomized studies on the prevention of PONV, with transdermal scopolamine, ondansetron and propofol, in middle ear surgery under general anaesthesia.
Results: The patients in the residents' group suffered more from PONV (69% vs. 42%, P <0.01) and from retching or vomiting (52% vs. 23%, P <0.001) than those in the specialists' group. The proportion of patients needing droperidol was also higher in the residents' group (66% vs. 27%, P <0.001). The durations of anaesthesia and surgery seemed to correlate positively with PONV. In matched-pair analysis, residentship was confirmed as a risk factor for emetic symptoms. In the residents' group, prophylaxis of PONV resulted in a decrease in retching and vomiting from 71% to 29% ( P <0.01), and in patients needing droperidol from 87% to 46% ( P <0.01).
Conclusion: The patients operated by residents need more aggressive prophylaxis for PONV than those operated by specialists in middle ear surgery.     

Postoperative symptoms at home following day-case surgery in children: a multicentre survey of 551 children

The incidence and duration of postoperative symptoms in children at home following day-case anaesthesia and surgery was evaluated using a questionnaire completed by parents of 551 children aged 4 months to 13.4 years (mean 3.8 years). They also evaluated the instructions given in hospital for care at home. The incidence of all symptoms was highest at home on the day of the operation. No postoperative symptoms were reported in 79 (14%) children. The incidence of pain was 56% and the only significant predictor was the type of operation, tonsillectomy being the most problematic (mild pain in 38% and severe in 25%; pain lasted 7 days or longer in 33%). Analgesics were given to 78% of all the children reported to have pain on the day of the operation, to 60% the next day and later to 58%; 19 (3%) children were given more than two doses per day. The instructions given in hospital for the treatment of pain were considered inadequate by 12% of parents. Postoperative nausea and vomiting occurred in 13% of children. Predictors by multiple stepwise logistic regression analysis were emetic symptoms in hospital, pain at home, age > 5 years and administration of postoperative opioid (pethidine or fentanyl). Opioid given during anaesthesia (fentanyl or alfentanil) did not increase the incidence. Emetic symptoms were most common after tonsillectomy (31%). The highest incidences of emetic symptoms (37%), sedation (96%) and dizziness (41%) occurred in children who had been given fentanyl for postoperative pain. Undertreatment of nausea in hospital was evident as only two children had received anti-emetics, even though 61 were reported to have emetic symptoms. Administration of effective anti-emetics should be encouraged, as emetic symptoms in hospital were the most significant predictor of nausea and vomiting at home. Treatment of pain at home and instructions for treatment of pain need to be improved.     

Postoperative complaints after spinal and thiopentone-isoflurane anaesthesia in patients undergoing orthopaedic surgery Spinal versus general anaesthesia

Background. The present prospective study investigates the impact of a standardized technique of spinal and general anaesthesia on the incidence and consequences of postanaesthetic complaints dependent on age and sex of patients.
Methods. 433 orthopaedic patients underwent lower limb surgery in spinal (group 1) or general (group 2) anaesthesia. Spinal anaesthesia was performed with 0.5% hyperbaric bupivacaine using a 26-gauge Quincke needle. General anaesthesia was induced with i.v. injection of thiopentone, fentanyl and atracurium and maintained with 65% nitrous oxide and 1-1.5 Vol% isoflurane in oxygen. On postoperative day 4, patients were interviewed for onset and duration of postoperative complaints.
Results. The overall incidence of nausea/vomiting ( P =0.025) and sore throat ( P =0.001) was higher in group 2. In addition, nausea/vomiting was higher in patients between 20 and 60 years in group 2 compared with group 1. While the incidence of urinary dysfunction was higher in men after spinal ( P =0.04), nausea/vomiting was more frequent in women after general anaesthesia ( P =0.008). Analgetic requirements ( P =0.013), time of postoperative surveillance ( P =0.042) and frequency of treatment of postoperative complaints ( P =0.0001) was higher in group 2.
Conclusion. Spinal anaesthesia was associated with a lower incidence of postoperative complaints and treatments and a shorter surveillance compared to general anaesthesia. Specific complications related to spinal anaesthesia did not depend on age or sex and may allow for recommendation of this technique even in younger and female patients undergoing orthopaedic surgery.     

A survey of postoperative nausea and vomiting

A prospective interview-based survey on the incidence of postoperative nausea and vomiting in 1107 in-patients aged 4–86 years was conducted during a 3-month period. Nausea, emetic episodes and the need for anti-emetic medication were recorded for 24 h postoperatively. In the recovery room, the incidence of nausea and vomiting was 18% and 5%, respectively. Over the whole 24-h period, these figures were 52% and 25%, respectively; severe nausea was experienced by 8%. The highest incidence of emetic sequelae was observed in gynaecological patients; 52% of the 822 patients who received general anaesthesia and 38% of the 285 patients who received regional anaesthesia reported nausea. The most important predictive factors associated with an increased risk for nausea and vomiting were female gender, a previous history of postoperative sickness, a longer duration of surgery, nonsmoking and a history of motion sickness. Based on these five items, a simple score predicting the risk of nausea and vomiting was constructed with a moderately good discriminating power.     

Postoperative symptoms 24 hours after ambulatory anaesthesia

Purpose

To test the hypothesis that the type of surgical procedure influences the incidence of postoperative symptoms. Also the effect of demographic and clinical risk variables: age, sex, ASA status, duration of anaesthesia on the postoperative symptoms were evaluated for each type of surgery.

Methods

Demographic, medical, anaesthetic and surgical data on 1,017 patients were prospectively collected by a research assistant who telephoned each patient 24 hr after discharge to administer a questionnaire to determine postoperative symptoms. Postoperative symptoms included incisional pain, nausea/vomiting, drowsiness, dizziness, headache and fever. In addition, 270 patients were asked the % (0–100) of their return to daily living function at 24 hr.

Results

Incisionat pain (26.9%), headache (11.6%), and drowsiness (11.5%) were the most frequently reported symptoms. Dizziness was reported by 9.7% and nausea/vomiting by 7.1%. Approximately 50% of patients undergoing laparoscopy, orthopaedic and general surgery reported 24-hr postoperative incisionat pain. The incidence of 24-hr postoperative nausea/vomiting was highest after general 17.4%, orthopaedic, 11.2%, and laparoscopic surgery, 9.4%. Drowsiness was highest after laparoscopy 36.1%, followed by general surgery, 21.4%. Dizziness was most frequent after laparoscopy, 24.1%, followed by general surgery, 16.1%. After laparoscopy, postoperative drowsiness or dizziness was related to anaesthesia duration. After general surgery, postoperative dizziness or drowsiness were related to age; the younger the patient, the more likely the symptoms.

Conclusions

Postoperative pain, nausea/vomiting, drowsiness, dizziness, and headache were the more frequent postoperative symptoms 24 hr after ambulatory surgery and they were influenced by the type of surgical procedure. In addition, the type of surgery and the 24-hr postoperative symptoms determined the degree of return to daily living function.     

Postanaesthetic nausea in children

The incidence of emetic episodes during the first 24 h after anaesthesia was studied prospectively in 485 children aged 0-16 years in relation to age, premedication, type of induction, type and duration of anaesthesia, type of surgery and use of postoperative analgesics. The incidence of emetic episodes was 25% in the whole material. The majority of the emetic episodes were recorded after the immediate recovery period. In children under 2 years of age, vomiting was only recorded in 5%. Nausea and vomiting was most common after squint surgery (75%) and least common after endoscopies (17%). Neither premedication with diazepam nor the method of induction (thiopentone, i.v., thiopentone rectally, inhalation with halothane) influenced the incidence of nausea. For the same type of surgery, maintenance of anaesthesia with halothane resulted in a lower incidence of nausea than anaesthesia with fentanyl-pancuronium.     

Postoperative nausea and vomiting in patients undergoing total abdominal hysterectomy under spinal anaesthesia: a randomized study of ondansetron prophylaxis

BACKGROUND AND OBJECTIVE: Patients undergoing total abdominal hysterectomy under general anaesthesia have a high risk of developing postoperative nausea and vomiting (PONV). The aim of this study was to evaluate the incidence of PONV in patients undergoing total abdominal hysterectomy under spinal anaesthesia with intravenous patient-controlled analgesia (PCA) using morphine and to compare its incidence with and without antiemetic prophylaxis. METHODS: Thirty-four patients undergoing total abdominal hysterectomy under spinal anaesthesia with i.v. PCA morphine postoperatively were divided into two groups. The first (n = 17) received ondansetron prophylaxis near the end of surgery while the second (n = 17) received no prophylaxis. Morphine consumption, emetic episodes (on a 3-point scale), patient satisfaction (visual analogue score), sedation and pruritus were evaluated 2, 4, 6, 9, 12, 18 and 24h postoperatively. RESULTS: Patient characteristics, postoperative morphine consumption (43.3 +/- 7.6 vs. 40.3 +/- 12.3 mg) and peristaltic recovery time (16.9 +/- 5 vs. 18.4 +/- 5.2 h) were similar in both groups. Overall nausea and vomiting were significantly lower in the ondansetron prophylaxis group than in the group without prophylaxis (52.9% vs. 88.2%, P < 0.05). Though nausea alone was higher in the prophylaxis group (41.2% vs. 29.4%), nausea with vomiting was significantly lower in the prophylaxis group (11.8% vs. 58.8%, P < 0.01). Patients' satisfaction scores were higher in the ondansetron group at all times and the difference was significant (P < 0.05) 4 h postoperatively. CONCLUSIONS: The incidence of PONV in patients undergoing total abdominal hysterectomy under spinal anaesthesia with i.v. PCA morphine is very high (88.2%). Antiemetic prophylaxis with ondansetron is highly recommended in this patients group resulting in a lower incidence of nausea and vomiting, and significantly improves patient' satisfaction and life quality in the early postoperative period.     

Prophylactic oral dolasetron mesylate reduces nausea and vomiting after abdominal hysterectomy

Purpose

The incidence of postoperative nausea and vomiting (PONV) varies from 50% to 75% after gynaecological surgery under general anaesthesia. This study evaluates the dose-response relationships, safety, and efficacy of the new 5-HT₃ antagonist, dolasetron mesylate, in the prevention of PONV in women undergoing total abdominal hysterectomy (TAH).

Methods

Three hundred and seventy four women scheduled for TAH under general anaesthesia were studied at 13 Canadian centres. Patients received in a randomized, double-Wind manner 25, 50, 100, or 200 mg dolasetron or placebo po one to two hours before induction of anaesthesia. The anesthetic protocol was standardized. Efficacy was evaluated for 24 hr after surgery by companng the number of emetic episodes, administration of rescue medication, seventy of nausea, and patient satisfaction.

Results

Analysis of complete response (no emetic episodes and no rescue for 24 hr) revealed a linear doseresponse relationship across dolasetron groups (P < 0.002). Dolasetron 100 mg (P < 0.003) and 200 mg (P < 0.01) were superior to placebo. The percentage of patents with no emetic episodes increased from 29.3% (placebo) to 54.1 % (100 mg). Subgroup analysis revealed ASA status (I > II), previous history of PONV, previous history of motion sickness, and total morphine dose (> 55 mg associated with less PONV than < 55 mg) influenced the incidence of emetic symptoms, but did not alter the results of the primary analysis.

Conclusion

Prophylactic dolasetron (100 mg and 200 mg) reduces the incidence of PONV in patients having total abdominal hysterectomy.     

Droperidol prevents and treats nausea and vomiting after enflurane anaesthesia

One hundred and twelve women undergoing elective orthopaedic surgery under enflurane anaesthesia were given, in a double-blind random fashion, 2.5 mg of droperidol i.m. before anaesthesia, or 1.25 mg of droperidol or a saline placebo i.v. at the end of anaesthesia in an attempt to prevent post-operative vomiting. The administration of droperidol 1.25 mg (for those receiving initially 1.25 mg of droperidol) or saline (for those receiving initially 2.5 mg of droperidol or saline) was repeated i.m. during the 24 post-operative hours in a blind manner if the patient complained of nausea, retched or vomited. Significantly fewer patients (P less than 0.05) given i.m. or i.v. droperidol had emetic symptoms than patients given saline. Furthermore, 51% of the patients given saline needed additional doses of saline, whereas only 27% of the patients given i.m. and 36% of the patients given i.v. droperidol required a second dose (P less than 0.05 between groups). More of the patients given saline (23%) than those given droperidol (8% to 9%), as a blind drug (P less than 0.05), needed to be given additional droperidol as a known anti-emetic because of the failure of the blind drug to prevent or treat symptoms. It is concluded that droperidol given either as a single dose of 2.5 mg i.m. or in repeated doses of 1.25 mg i.v. is effective in the prevention and treatment of post-operative nausea and vomiting after enflurane anaesthesia.     

Ondansetron compared with metoclopramide in the treatment of established postoperative nausea and vomiting

We have studied 746 males and females undergoing general anaesthesia for any type of surgical procedure in a double-blind, controlled, randomized study. After experiencing at least one nausea and/or one emetic episode in the 6 h after recovery from anaesthesia, patients received either ondansetron 4 mg i.v. or metoclopramide 10 mg i.v. Patients were observed for postoperative nausea and vomiting (PONV) for 24 h after drug administration. Complete control of PONV was achieved more frequently in the ondansetron-treated patients compared with the metoclopramide-treated patients during the 24-h period (59% vs 41% (P < 0.001) and 44% vs 34% (P = 0.006) for emetic episodes and nausea, respectively). Furthermore, ondansetron was associated with greater patient satisfaction than metoclopramide (P < 0.001) with 49% and 32% of patients, respectively, very satisfied. The overall incidence of adverse events was similar in the ondansetron (7%) and metoclopramide (8%) groups. Ondansetron was as well tolerated and more effective than metoclopramide for all assessment criteria in the treatment of established PONV.      

盐酸帕洛诺司琼预防上腹部手术后硬膜外吗啡镇痛所致的恶心呕吐

目的 观察和评价帕洛诺司琼对上腹部手术后硬膜外吗啡镇痛引起的恶心呕吐的预防效果和安全性.方法 择期行上腹部手术并术后接受硬膜外吗啡镇痛患者60例,随机分为帕洛诺司琼组（P组）和托烷司琼组（T组）.手术结束前30 min,P组患者缓慢静注帕洛诺司琼0.25 mg,T组患者缓慢静注托烷司琼6 mg.观察记录两组患者术后24 h、48 h VAS及Ramsay评分、恶心呕吐的程度,计算恶心呕吐有效控制率.同时记录患者腹胀、头痛、椎体外系症状等不良反应.结果 两组患者术后24 h及48 h的VAS及Ramsay评分差异无统计学意义.P组患者术后24 h的恶心及呕吐有效控制率分别为80.0%和73.3%,T组分别为63.3%和60.0%;P组患者术后48 h的恶心及呕吐有效控制率分别为90.0%和93.3%,T组分别为66.6%和63.3%.两组患者术后24 h恶心、呕吐有效控制率差异无统计学意义.P组患者术后48 h恶心、呕吐有效控制率明显优于T组患者（P 〈 0.05）.帕洛诺司琼的不良反应主要为头痛.结论 腹部手术后24 h内,帕洛诺司琼预防吗啡硬膜外镇痛所致的恶心呕吐的效果与托烷司琼相当,但术后48 h预防恶心呕吐的效果优于托烷司琼,且不良反应发生率低,程度较轻,安全性好.     

Anaesthetic practice and postoperative pulmonary complications

The aim of this study was to identify risk factors associated with postoperative pulmonary complications. The influence of the anaesthetic technique was evaluated (i.e. general contra regional anaesthesia and long contra intermediately acting muscle relaxants (pancuronium and atracurium)) taking into account the patient's age, the presence or absence of chronic obstructive lung disease (preoperative risk factors), the type of surgery and the duration of anaesthesia (perioperative risk factors). Seven thousand and twenty-nine patients undergoing abdominal, urological, gynaecological or orthopaedic surgery were included in the study. A total of 290 patients (4.1%) suffered from one or more postoperative pulmonary complications. Six thousand and sixty-two patients received general anaesthesia and 4.5% of these had postoperative pulmonary complications. Of the patients admitted to major surgery receiving pancuronium, 12.7% (135/1062) developed postoperative pulmonary complications, compared to only 5.1% (23/449) receiving atracurium (P < 0.05). When stratified for type of surgery and duration of anaesthesia, conventional statistics showed no difference between pancuronium and atracurium as regard postoperative pulmonary complications. However, a logistic regression analysis indicated that long-lasting procedures involving pancuronium entailed a higher risk of postoperative pulmonary complications than did other procedures. In patients having regional anaesthesia, only 1.9% (18/967) developed postoperative pulmonary complications (P < 0.05 compared to general anaesthesia). However, when stratified for type of surgery there was a significantly higher incidence of postoperative pulmonary complications only in patients undergoing major orthopaedic surgery under general anaesthesia, 11.5% compared to 3.6% in patients given a regional anaesthesia.(ABSTRACT TRUNCATED AT 250 WORDS)     

Comparative effects of intravenous ketorolac and pethidine on perioperative analgesia and postoperative nausea and vomiting (PONV) for paediatric strabismus surgery

BACKGROUND: Corrective strabismus surgery is associated with moderate pain and a very high incidence of postoperative nausea and vomiting (PONV). Ketorolac tromethamine, a nonsteroidal anti-inflammatory drug, is a popular analgesic in adults. There are only limited published data on the use of intravenous ketorolac for paediatric analgesia perioperatively. This study evaluated and compared the emetic and analgesic effect of ketorolac with pethidine and its suitability for this kind of surgery. METHODS: Following institutional ethics committee approval and parental consent, 52 ASA class I children of age 2.5 to 15 yr were randomised to receive either ketorolac 0.9 mg kg-1 or pethidine 0.5 mg kg-1 given intravenously (i.v.). A blinded observer assessed recovery by Steward's method immediately after arrival at the post anaesthesia care unit (PACU), pain by validated Objective Pain Score (OPS) at 0 h, 1/2 h and 1 h after arrival at the PACU and PONV by Numeric Rank Score at specified time intervals. RESULTS: There were no differences in demographic data, anaesthesia time or surgery duration. Recovery scores, OPS and postoperative analgesic requirement were similar in both groups. PONV at various time intervals for the first 24 h, occurred more frequently in the pethidine group as compared to the ketorolac group (P < 0.001) There were no side effects observed with either drug. CONCLUSION: Ketorolac in a dose of 0.9 mg kg-1 i.v. at the induction of anaesthesia is as effective as pethidine 0.5 mg kg-1 i.v. as an analgesic and is associated with significantly less PONV.     

The effects of tramadol on postoperative nausea, vomiting and headache after ENT surgery. A placebo-controlled comparison with equipotent doses of nalbuphine and pethidine

Background: Opioids given as adjuncts to balanced inhalational anaesthesia augment postoperative nausea and vomiting (PONV). Tramadol, equipotent to pethidine, does not depress respiration, but can cause an increase in blood pressure and headache via its monoaminergic actions. Nalbuphine, ten times as potent as pethidine, has a ceiling respiratory depressant and ceiling analgesic effect at >0.3 mg · kg^?1. We compared the effects of equipotent doses of tramadol and nalbuphine (3.0 and 0.3 mg · kg^?1, respectively) given as analgesic with induction of anaesthesia on emesis during recovery from anaesthesia and on PONV and headache until 24 h after ENT surgery, using saline (0.2 ml · kg^?1) and an equipotent dose of pethidine (1.5 mg · kg^?1) as controls. Method: The study population (N=281) comprised 4 comparable subgroubs (N=69 to 71 each). Anaesthetic medications were standardised. Emesis during recovery from anaesthesia and nausea, vomiting, retching, headache and administrations of antiemetic and analgesics until 24 h after surgery were recorded. Results: Emesis and antiemetic requirements during recovery from anaesthesia were similar and infrequent in each group, as were the incidences of nausea alone (3 to 5%), vomiting alone (17 to 31%), and nausea with vomiting (10 to 22%) during the first 24 h after surgery. However, any complaint of PONV was least frequent in the saline and pethidine groups (32% and 37%, respectively) and most frequent in the tramadol and nalbuphine groups (49% and 52%, respectively; P<0.05 versus saline, both comparisons; P=NS versus pethidine, both comparisons). The times to onset and severity of PONV were similar in each group, but patients given nalbuphine most frequently (P<0.025) needed rescue antiemetic to treat PONV. Headache occurred with similar frequency in each group. Conclusion: It is concluded that tramadol, nalbuphine and pethidine have similar emetic effect in the doses and manner used, and that tramadol does not increase the incidence of postoperative headache when used as peroperative analgesic.     

Metoclopramide does not decrease the incidence of nausea and vomiting after alfentanil for outpatient anaesthesia

Sixty patients were studied in a randomized, double-blind manner to determine whether metoclopramide added to droperidol decreased further the incidence of emetic symptoms (nausea, retching, vomiting) in outpatients receiving alfentanil anaesthesia for nasal surgery. Group 1 (n = 30) received metoclopramide 0.15 mg.kg-1 and Group 2 (n = 30) received placebo. In addition, both groups received droperidol 0.02 mg.kg-1 immediately before anaesthesia which was supplemented by alfentanil 20 micrograms.kg-1 at induction followed by an infusion of 0.25-1 micrograms.kg-1.min-1. Emetic symptoms were assessed 0-3 hr, 3-6 hr and 6-24 hr after surgery. Both groups received similar doses of alfentanil (mean +/- SD; Group 1 4641 +/- 1894 micrograms, Group 2 4714 +/- 1640 micrograms). The percentage of patients who had either nausea or vomiting at 0-3, 3-6 or 6-24 hr was 23%, 14% and 13% in Group 1; and 20%, 17% and 10% in Group 2. The overall incidence for each group was 8/30 (27%). There was no difference in the incidence of emetic symptoms between the groups at any time interval or throughout the study. Metoclopramide did not improve upon the antiemesis of droperidol during alfentanil anaesthesia for outpatient nasal surgery.     

Comparison of subhypnotic doses of thiopentone vs propofol on the incidence of postoperative nausea and vomiting following middle ear surgery

Background : Middle ear surgery is associated with a high incidence of emetic sequelae and propofol has been reported to have antiemetic activity in subhypnotic doses.
Methods : In a double-blind, randomized study, the patients received either thiopentone 1.0 mg.kg^-1 (n=26) or 0.5 mg.kg^-1 propofol (n=26) at the end of middle ear surgery under isoflurane-N₂O-fentanyl-vecuronium anaesthesia. Trained nurses, unaware of the group assignment, assessed postoperative nausea, retching and vomiting up to 24 h after the end of anaesthesia. Droperidol 10μg.kg^-1 was used as a "rescue" antiemetic.
Results : The main result was that the patients in the propofol group did not suffer from retching and vomiting (R&V) during the first 6 h, whereas these symptoms occurred in 46% ( P <0.001) of the patients in the thiopentone group. The patients in the propofol group needed significantly less droperidol during the first 24 h (mean number of doses 0.39 ± 0.57 (SD)) than the patients in the thiopentone group (1.35 ± 1.47, P <0.005). Treatment with propofol was a predictor for lowered incidence of R&V, as well as male gender and negative history of motion sickness.
Conclusion : Propofol at a subhypnotic dose of 0.5 mg.kg^-1 provides prophylaxis against retching and vomiting for the first 6 h postoperatively after middle ear surgery. The incidence of nausea was not reduced by propofol.     

Intravenous fluid and postoperative nausea and vomiting after day-case termination of pregnancy

Background : Deprivation of oral fluid before minor surgery has been alleged to cause postoperative nausea. We examined the effect of intraoperative fluid load on postoperative nausea and vomiting over 3 d after day-case termination of pregnancy.
Methods : In a randomized study, 100 patients were allocated into one of two groups; receiving 1000 ml of compound sodium lactate solution during surgery or no intraoperative fluid. Propofol and alfentanil was used to induce and maintain anaesthesia with nitrous oxide (67%) and oxygen (33%). Visual analogue scores for nausea and pain, the time and frequency of emetic episodes, analgesic and antiemetic consumption were recorded for 3 d postoperatively.
Results : The scores of nausea were significantly lower in the fluid group ( P <0.05) compared with the control group at 1, 2, 4 h and during 24–48 h following surgery. The incidence of emesis was lower ( P <0.01) after discharge, and the time to first oral fluid was shorter ( P <0.05) in the fluid group. There was no difference in pain score or analgesic consumption between the groups. Five patients (10%) in the control group requested antiemetic medication compared with none in the fluid group.
Conclusion : Intraoperative fluid administration may offer some benefit in decreasing the incidence of postoperative nausea and vomiting following day-case surgery.