Dexamethasone 8 mg in combination with ondansetron 4 mg appears to be the optimal dose for the prevention of nausea and vomiting after laparoscopic cholecystectomy

PURPOSE: The combination of antiemetic drugs could be a solution to prevent severe postoperative nausea and vomiting (PONV). The aim of this randomized double blind, dose-ranging study was to determine the minimum single effective dose of dexamethasone combined with ondansetron for the prevention of PONV in patients undergoing laparoscopic cholecystectomy. METHODS: One hundred eighty patients were allocated randomly to one of six groups to receive saline (P group), ondansetron 4 mg (O group), or ondansetron 4 mg and dexamethasone at doses of 2 mg (OD2 group), 4 mg (OD4 group), 8 mg (OD8 group), and 16 mg (OD16 group). A standardized general anesthetic was used. All episodes of PONV during the intervals of zero to six hours, 6-12 hr and 12-24 hr after surgery were evaluated using a numeric scoring system. Mean visual analogue scale pain scores at rest and on movement, the time to first demand of analgesia, total analgesic consumption in 12 hr epochs, duration of hospital stay, and side effects were recorded. RESULTS: The incidence of PONV in the OD8 (16%) and OD16 (16%) groups was lower than in the 83% (P < 0.001) and O groups (50%) at the 12-24 hr epoch (P < 0.05). There were no differences in antiemetic effect between the O, OD2 and OD4 groups and between the OD8 and OD16 groups. Pain scores, total analgesic consumption, duration of hospital stay and side effects were similar among groups. CONCLUSION: Our results suggest that 8 mg is the minimum dose of dexamethasone that, combined with ondansetron 4 mg will effectively prevent PONV in patients undergoing laparoscopic cholecystectomy.     

Oxycodone vs. fentanyl in the treatment of early post-operative pain after laparoscopic cholecystectomy: a randomised double-blind study

Background: It has been suggested that oxycodone is superior to other opioids in the treatment of visceral pain. We therefore compared the effect of intravenous (i.v.) oxycodone and i.v. fentanyl on post-operative abdominal (visceral) pain after outpatient laparoscopic cholecystectomy.
Methods: Seventy-eight patients were randomised to intra- and post-operative pain treatment with either oxycodone ( n =39) or fentanyl ( n =39). The patients received 10 mg oxycodone/100 μg fentanyl at the end of anaesthesia. In the post-anaesthetic care unit (PACU), 5 mg oxycodone/50 μg fentanyl was administered to patients with moderate pain [3–5 on a numeric rating scale (NRS)], and 10 mg oxycodone/100 μg fentanyl was administered to patients with severe pain (>5 on an NRS). The following measures were recorded: intensity of pain at arrival, after 30, 60 and 90 min and at discharge from the PACU; total consumption of oxycodone/fentanyl; nausea; vomiting; sedation and pressure tolerance thresholds.
Results: The median intra- and post-operative consumption of oxycodone was 15 mg (range: 10–40 mg) and the consumption of fentanyl was 200 μg (range: 100–500 μg). The intensity of abdominal pain was significantly lower in the oxycodone group at arrival ( P <0.05), after 30, 60 and 90 min, and at discharge from the PACU ( P <0.01). There was a strong tendency towards more side effects with oxycodone.
Conclusions: Oxycodone provided better analgesia but also more side effects, suggesting that the doses used in the present study may not be equipotent.     

Ondansetron, granisetron, and dexamethasone compared for the prevention of postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy

BACKGROUND: Laparoscopic cholecystectomies are associated with an appreciably high rate of postoperative nausea and vomiting (PONV). This study was designed to compare the effectiveness of ondansetron, granisetron, and dexamethasone for the prevention of PONV in patients after laparoscopic cholecystectomy. METHODS: A total of 80 American Society of Anesthesiologists (ASA) physical class I-II patients scheduled for laparoscopic cholecystectomy were included in this randomized, double blind, placebo-controlled study. All patients received a similar standardized anesthesia and operative treatment. Patients were randomly divided into four groups (n = 20 each). Group 1, consisting of control patients, received 0.9% NaCl; group 2 patients received ondansetron 4 mg i.v.; group 3 patients received granisetron 3 mg i.v.; and group 4 patients received dexamethasone 8 mg i.v., all before the induction of anesthesia. Both nausea and vomiting were assessed during the first 24 h after the procedure. RESULTS: The total incidence of PONV was 75% with placebo, 35% with ondansetron, 30% with granisetron, and 25% with dexamethasone. The incidence of PONV was significantly less frequent in groups receiving antiemetics (p < 0.05). The differences between dexamethasone, granisetron, and ondansetron were not significant. CONCLUSIONS: Prophylactic dexamethasone 8 mg i.v. significantly reduced the incidence of PONV in patients undergoing laparoscopic cholecystectomy. Dexamethasone 8 mg was as effective as ondansetron 4 mg and granisetron 3 mg, and it was more effective than placebo.     

Early recovery, cognitive function and costs of a desflurane inhalational vs. a total intravenous anaesthesia regimen in long-term surgery

BACKGROUND: The purpose of the study was to compare time of recovery, return of cognitive function, post-anaesthetic care unit (PACU) stay and costs of a propofol/remifentanil (TIVA) with a desflurane/fentanyl-based anaesthesia (desflurane group) in surgical procedures lasting more than 150 min. METHODS: Forty-nine patients undergoing elective abdominal prostatectomy were allocated randomly to receive bispectal index (BIS)-controlled desflurane/fentanyl (n=24) or propofol/remifentanil (n=25). Awakening, clinical recovery, direct drug acquisition and post-operative pain treatment were documented. Cognitive skills were tested using the Mini-Mental Status (MMST) test. RESULTS: Extubation was significantly faster with desflurane (6.9+/-3.5 min) than with TIVA (11.2+/-4.0 min) as well as times for stating name and date of birth (desflurane: 6.1+/-3.9 and 6.6+/-4.0 min; TIVA: 12.4+/-11.5 min and 13.4+/-11.3 min). There were no significant differences in PACU discharge times or MMS scores between the groups. Significantly more patients suffered post-operative nausea and vomiting (PONV) in the desflurane (33% vs. 0%) than the TIVA group. Overall costs were significantly higher in the TIVA (58.8+/-11.6 euro) than in the desflurane group (35.0+/-5.7 euro). CONCLUSION: Patients undergoing prolonged surgical procedures showed a faster early recovery after desflurane/fentanyl than using TIVA, whereas stay in the PACU and recovery of cognitive function were similar in both groups. Costs of a TIVA regimen were significantly higher than using a desflurane-based anaesthesia technique.     

Incidence and severity of postoperative nausea and vomiting are similar after metoclopramide 20 mg and ondansetron 8 mg given by the end of laparoscopic cholecystectomies

BACKGROUND: Ondansetron has a well documented antiemetic prophylactic effect, whereas in most studies of postoperative nausea and vomiting (PONV), metoclopramide is less efficacious. This can be attributed to the short-lasting effect of metoclopramide when a low dose is given at the beginning of surgery. We wanted to test a 20-mg dose of metoclopramide given at the end of surgery, using ondansetron 8 mg as a reference. METHODS: 122 patients scheduled for elective laparoscopic cholecystectomy under general anesthesia were studied in a randomized, double-blind study design. At the end of the procedure, the patients received either metoclopramide 20 mg or ondansetron 8 mg intravenously. The patients were observed for 24 h for PONV, pain, side-effects and need for rescue antiemetic medication. RESULTS: No significant differences in the incidence of PONV or need for rescue antiemetic treatment was observed in the 0-24 h postoperative study period. The overall incidence of PONV was 43% in the ondansetron group and 47% in the metoclopramide group. The ondansetron patients had a significantly higher incidence of moderate or strong pain during the postoperative observation period (61% vs. 35% in the metoclopramide group) (P < 0.05). No significant differences in side-effects between the groups were observed. CONCLUSIONS: Metoclopramide 20 mg i.v. given at the end of laparoscopic cholecystectomy resulted in a similar incidence of PONV compared with ondansetron 8 mg. The patients receiving metoclopramide had less pain than the patients receiving ondansetron.     

舒芬太尼在日间腹腔镜胆囊切除术的临床应用

目的:探讨舒芬太尼-七氟烷静吸复合麻醉在日间腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)中的应用价值。方法:将择期行日间LC的患者随机分为观察组与对照组,每组20例,观察组使用舒芬太尼(0.4μg/kg)进行麻醉,对照组使用芬太尼(4μg/kg)麻醉。观察两组患者麻醉期(术前到拔管)及术后生命体征(BP、HR、SPO2)、手术时间、苏醒时间、拔管时间、PACU躁动发生率及躁动程度、术后疼痛分级、术后镇痛药及麻醉并发症等指标。结果:两组患者麻醉诱导后血压、心率均较术前下降(P<0.05),组间相比差异无统计学意义(P>0.05);观察组苏醒时间及拔管时间、意识恢复时间、术后疼痛指数均优于对照组,差异有统计学意义(P<0.05);观察组PACU躁动发生率为5%,对照组为20%。结论:舒芬太尼较芬太尼在镇痛效果、镇痛时间、术后意识恢复、降低术后躁动发生率等方面具有一定优势,应用于日间LC的麻醉安全、有效。     

Recovery profile and side effects of remifentanil-based anaesthesia with desflurane or propofol for laparoscopic cholecystectomy

BACKGROUND: Nitrous oxide (N2O) has been suggested to contribute to bowel distension, resulting in worsened operating conditions for laparoscopic surgery, and to increase incidence of postoperative nausea and vomiting. Therefore, our objective was to assess the feasibility of two remifentanil-based anaesthetic regimens free from N2O with special regard to recovery profile, postoperative analgesic demand and side effects in patients undergoing laparoscopic cholecystectomy. METHODS: Fifty patients (ASA I-II, 23-65 yr) were randomly assigned to receive remifentanil-based anaesthesia in conjunction with propofol (group R/P) or desflurane (group R/D). After standardised induction of anaesthesia, analgesia was continued with remifentanil in all patients. For maintenance of hypnosis, propofol or desflurane were used in concentrations to ensure loss of consciousness, lack of awareness, and maintenance of heart rate and blood pressure within +/- 25% of initial values. At the end of surgery all anaesthetics were discontinued without tapering and early emergence and recovery were recorded. Pain scores were assessed by using a visual analogue scale. Patient-controlled analgesia with i.v. piritramide was used for treatment of postoperative pain and recorded for 90 min in the postanaesthesia care unit (PACU). In addition, side effects were noted. RESULTS: Early emergence from anaesthesia did not differ between the groups. In group R/P, time to eye opening, spontaneous respiration and extubation was 4.4 +/- 2.9 min, 5.2 +/- 3.4 min and 5.5 +/- 3.3 min respectively, compared with 4.7 +/- 2.7 min, 5.3 +/- 2.4 min and 5.7 +/- 2.5 min in group R/D. While pain scores did not differ between both groups on admission to the PACU, patients receiving desflurane required more i.v. piritramide as compared to those receiving propofol, 22.0 +/- 6.5 mg and 17.9 +/- 7.0 mg, respectively (P<0.05). Nausea was less frequent after propofol (16% vs. 48%, P<0.05). CONCLUSION: In patients undergoing laparoscopic cholecystectomy, remifentanil-based anaesthetic regimens in conjunction with propofol or desflurane are suitable and allow for rapid recovery from anaesthesia. However, the use of propofol results in less postoperative analgesic consumption and nausea as compared to desflurane.     

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.     

Acupressure and ondansetron for postoperative nausea and vomiting after laparoscopic cholecystectomy

PURPOSE: To compare the efficacy of acupressure wrist bands and ondansetron for the prevention of postoperative nausea and vomiting (PONV). METHODS: One hundred and fifty ASA I-II, patients undergoing elective laparoscopic cholecystectomy were included in a randomized, prospective, double-blind and placebo-controlled study. Patients were divided into three groups of 50. Group I was the control; Group II received ondansetron 4 mg iv just prior to induction of anesthesia; in Group III acupressure wristbands were applied at the P6 points. Acupressure wrist bands were placed inappropriately in Groups I and II. The acupressure wrist bands were applied 30 min prior to induction of anesthesia and removed six hours following surgery. Anesthesia was standardized. PONV were evaluated separately as none, mild, moderate or severe within six hours of patients' arrival in the postanesthesia care unit and then at 24 hr after surgery by a blinded observer. If patients vomited more than once, they were given 4 mg ondansetron iv as the rescue antiemetic. Results were analyzed by Z test. A P value of < 0.05 was taken as significant. RESULTS: The incidence of PONV and the requirement of rescue medication were significantly lower in both the acupressure and ondansetron groups during the first six hours. CONCLUSION: Acupressure at P6 causes a significant reduction in the incidence of PONV and the requirement for rescue medication in the first six hours following laparoscopic cholecystectomy, similar to that of ondansetron 4 mg iv.     

Optimization of anesthesia antiemetic measures versus combination therapy using dexamethasone or ondansetron for the prevention of postoperative nausea and vomiting

Background  

More than half of the patients undergoing laparoscopic cholecystectomy experience postoperative nausea and vomiting (PONV). This condition is related to the surgical, anesthetic, and patient factors. Volatile anesthetics, nitrous oxide, and opioids are known anesthetic risk factors for PONV, and thus preventive measures are justified. Propofol-based total intravenous anesthesia (TIVA), ondansetron, and dexamethasone each are reported to reduce PONV by approximately 30%. Avoiding or reducing perioperative narcotic analgesics, use of an 80% oxygen concentration, and proper intravenous fluid administration also reduce PONV. The anesthetic antiemetic measures have been studied separately. This study aimed to test the efficacy of these anesthetic antiemetic measures collectively with or without ondansetron or dexamethasone in preventing PONV among patients undergoing laparoscopic cholecystectomy.     

Does esomeprazole prevent post‐operative nausea and vomiting?

BACKGROUND: Esomeprazole is a potent proton pump inhibitor (PPI), reducing acid production as well as gastric juice volume. This study evaluated the possible beneficial effect of esomeprazole on reducing post-operative nausea and vomiting (PONV). METHODS: Patients undergoing laparoscopic or open gynaecological surgery, or laparoscopic cholecystectomy were randomized to receive three peri-operative doses double blindly of either esomeprazole 40 mg or placebo, given intravenously or orally. All patients were given a standardized anaesthesia regimen including fentanyl and sevoflurane/nitrous oxide. RESULTS: The study population consisted of 284 patients. Demographic data and known PONV risk factors were similar for the two treatment groups. PONV was observed in 77% of patients on esomeprazole vs. 81% on placebo (NS) and rescue antiemetic medication was needed in 56% vs. 53%, respectively (NS). The proportion of patients that vomited during 0-24 h was lower on esomeprazole than placebo (38% vs. 49%; NS), and the mean amount of vomit was significantly lower (52 vs. 86 g; P < 0.05). The use of neostigmine, use of opioids and type of surgery were significant risk factors for PONV (P < 0.05). The 24-h incidence of PONV was 63% after laparoscopic gynaecology, 80% after laparoscopic cholecystectomy and 88% after open gynaecological laparotomy, whereas laparoscopic cholecystectomy had the lowest risk when corrected for other risk factors of PONV. CONCLUSION: Esomeprazole had no clinically relevant effect on the overall 24-h incidence of PONV. However, esomeprazole significantly reduced the total amount of vomit during 24-h post-operatively. This may be of value in patients with an increased risk of pulmonary aspiration.     

Desflurane vs. sevoflurane as the main inhaled anaesthetic for spontaneous breathing via a laryngeal mask for varicose vein day surgery: a prospective randomized study

BACKGROUND: Sevoflurane has become widely used in day surgery; however, desflurane may be a valuable alternative even in this setting. This study compares emergence from anaesthesia for day surgery with spontaneous breathing using either desflurane or sevoflurane. METHODS: This prospective, randomized, single-blinded study examined 70 ASA III patients undergoing elective ambulatory varicose vein surgery. Primary endpoint was emergence time (cessation of anaesthetic gas to communicating). Secondary endpoints included post-operative pain, nausea, time to discharge, and patient satisfaction. Patients were anaesthetized according to a standardized protocol including multimodal analgesia and antiemetic therapy and were randomized to receive sevoflurane or desflurane as the main anaesthetic while breathing spontaneously through a laryngeal mask airway. Fresh gas flow was oxygen in air 1 : 2 l/min. RESULTS: Intra-operative anaesthesia was uneventful apart from airway irritation observed in 5/35 desflurane and 1/35 sevoflurane patients. Emergence was 25-40% faster in patients anaesthetized with desflurane. Pain and post-operative nausea and vomiting (PONV) were equally infrequent in both groups. Overall, patient satisfaction was high with no difference between the groups. CONCLUSION: Desflurane is associated with a faster emergence with no differences during the post-operative course except a somewhat higher incidence of airway irritation.     

Ondansetron in the prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy

Background: There is an increased incidence of postoperative nausea and vomiting (PONV) after laparoscopic cholecystectomy. The aim of the study was to evaluate the efficacy of intravenous ondansetron, a 5-HT anatagonist, for prevention from PONV after laparoscopic cholecystectomy. Methods: Sixty-eight patients were entered into the study. Thirty-six patients were randomized to receive a single intravenous dose of 4 mg of ondansetron before extubation. Thirty-two patients received no prophylaxis. There were no differences in terms of sex ratio, age, ASA status, and duration of operation between the two study groups. Patients were interviewed by an independent observer to assess the postoperative pain and nausea using visual analog score. Patients' satisfaction scores to the procedure were measured. Results: There was no complication in the series. Pain scores at 2 and 24 h after operation and analgesics consumption were not different between the two groups. For the patients who received ondansetron, the mean (SD) nausea score at 2 and 24 h was 1.5 (1.2) and 1.4 (1.4), respectively. The score for the control group was 1.4 (1.0) and 1.2 (0.5), respectively. There was also no difference in episodes of vomiting and usage of antiemetics between the two groups. Both groups were equally satisfied with the procedures. Conclusion: Routine use of ondansetron does not reduce the incidence of postoperative nausea and vomiting after laparoscopic cholecystectomy.     

Retracted: Do patients profit from physostigmine in recovery from desflurane anaesthesia?

BACKGROUND: Physostigmine is the drug of choice in the central anticholinergic syndrome, but has also been used in post-operative mental derangement secondary to sedatives and volatile anaesthetics. The aim of this double-blind, randomized, prospective study was to determine whether physostigmine alters recovery after desflurane anaesthesia. METHODS: One hundred patients undergoing urologic or surgical procedures were enrolled to receive either NaCl 0.9% (n = 50) or 2 mg of physostigmine (n = 50) at the end of general anaesthesia with propofol, fentanyl, cisatracurium and desflurane. Times to extubation, stating name, birthday and place of residence, and obeying commands such as eye opening and hand squeezing were noted. Haemodynamics, Aldrete and pain scores, the analgesic requirements, and any adverse side-effects were documented until the 1st post-operative day. RESULTS: Demographic, peri-operative data including duration of anaesthesia, surgery and postanaesthetic care unit (PACU) stay, and consumption of anaesthetics were comparable in both groups. No significant difference between the groups was found for extubation time or other emergence parameters. Patients undergoing anaesthesia >150 min showed after receiving physostigmine significantly (P < 0.05) faster spontaneous breathing (2.6 +/- 3.1 vs. placebo 5.0 +/- 4.2 min) and extubation time (6.2 +/- 3.7 vs. placebo 8.8 +/- 5.0 min). Women showed significantly shorter extubation times (5.5 +/- 3.4 min) and eye opening (5.5 +/- 2.6 min) with physostigmine than placebo (7.7 +/- 4.5 and 7.8 +/- 4.0 min). The incidence of post-operative nausea and vomiting (PONV) was significantly higher after physostigmine than placebo, whereas shivering occurred more often after placebo. CONCLUSION: Physostigmine does not alter desflurane-based anaesthesia compared with placebo. An option is to use physostigmine in patients with a duration of anaesthesia >150 min who profit in earlier return to spontaneous breathing and shorter extubation time.     

Postoperative vomiting reduction after laparoscopic cholecystectomy with single dose of dexamethasone

AIM: The incidence of postoperative nausea and vomiting (PONV) is high after laparoscopic surgery. A number of drugs have been used for prevention; in some studies a single dexamethasone dose before induction of anaesthesia has been effective. METHODS: To test the effectiveness of this therapy, we recruited 80 patients in a double-blind placebo-controlled study (dexamethasone 8 mg or placebo) scheduled for laparoscopic cholecystectomy. We measured nausea, vomiting, postoperative pain and length of stay. RESULTS: Patients who received preoperative dexamethasone had a reduction of PONV, but experienced the same degree of postoperative pain and remained in the hospital for the same duration. No apparent side effects were observed. CONCLUSION: Although only a small number of patients were tested, we confirm the efficacy of dexamethasone therapy for reduction of PONV. We suggest routine use of a single dose of dexamethasone for the prevention of PONV in laparoscopic cholecystectomy.     

Supplemental 80% oxygen does not attenuate post-operative nausea and vomiting after breast surgery

BACKGROUND: Although supplemental oxygen has been shown to be as effective as ondansetron in the prevention of post-operative nausea and vomiting (PONV) in one study in abdominal surgery patients, the antiemetic efficacy of supplemental oxygen is controversial on the basis of studies with other patients. We compared the efficacy of 80% and 30% oxygen in decreasing PONV in breast surgery. Ondansetron was used as an active control. METHODS: Ninety patients were given a standardized sevoflurane anesthetic. They were randomly assigned to three groups: 30% oxygen in nitrogen and saline 2 ml intravenously (i.v.) at the end of surgery (group 30); 80% oxygen in nitrogen and saline 2 ml (group 80); and 30% oxygen in nitrogen and ondansetron 4 mg (group O). Oxygen was administered during surgery and up to 2 h after surgery. RESULTS: The incidence of total response (no retching or vomiting, no nausea) during the first 24 post-operative hours was not different between group 80 (17%) and group 30 (11%) but was higher in group O (43%) than in group 30 (P<0.05). Compared with group O, patients in group 80 experienced more vomiting during the study period 0-24 h (66% vs. 32%; P<0.05) and more nausea during the period 6-24 h (72% vs. 39%; P<0.05). There was no difference between the groups in their risk for PONV, pain scores, opioid consumption, or patient satisfaction. CONCLUSIONS: In this study, supplemental 80% oxygen administration failed to decrease PONV in breast surgery.     

Individualized outcome feedback produces voluntary antiemetic prescribing practice changes.

STUDY OBJECTIVE: To determine the impact of individualized outcome feedback on antiemetic prescribing practices and compare outcomes of a cost-effective, standardized antiemetic protocol (PROT) to that of customized antiemetic therapy (NONPROT). DESIGN: Prospective, observational study with randomized component. SETTING: Postanesthesia care unit (PACU) of an academic medical center. PATIENTS: 3027 consecutive ASA physical status I, II, and III patients receiving general anesthesia. INTERVENTIONS: Patients were randomized to receive 0.625 mg droperidol or 4 mg ondansetron for postoperative nausea and/or vomiting (PONV) from a protocol, or received customized antiemetic therapy. MEASUREMENTS AND MAIN RESULTS: Incidence of PACU PONV, selection of PROT versus NONPROT, patient satisfaction, and use of PONV prophylaxis were measured and indexed by an attending anesthesiologist in a monthly report for 4 months. Monthly expenditures for antiemetic therapy prior to, during, and after the study were collected. Literature on PONV outcomes, appropriate timing, and selection of PONV prophylaxis was distributed. The NONPROT group was slightly older than the PROT group; otherwise, demographics were similar between all groups. The incidence of PONV did not differ between the PROT and NONPROT groups (11% vs. 10%), and the incidence of PONV in patients receiving prophylaxis was higher in both groups (17% PROT vs. 15% NONPROT). Patients receiving ondansetron as a first-line drug required rescue therapy less often (5%) than those receiving droperidol (14%); however, patient satisfaction was indistinguishable among all groups. During the study, the use of prophylaxis decreased 47% without an increase in PONV, and PROT selection increased 54%. CONCLUSIONS: Individualized outcome feedback produced a 48% reduction in monthly expenditures for ondansetron and droperidol, which was sustained after the study. Patients satisfaction between ondansetron 4 mg and droperidol 0.625 mg given in the PACU did not differ in spite of a slightly greater efficacy of ondansetron as a first-line drug.     

The effect of supplemental oxygen on postoperative nausea and vomiting in children undergoing dental work

Administration of 80% intraoperative oxygen has been proposed as being a cheap, safe and effective means of reducing postoperative nausea and vomiting (PONV) but no studies have been performed in the high risk paediatric population. We tested whether 80% intraoperative oxygen reduces PONV in well children undergoing elective day-stay dental treatment under general anaesthesia. Ninety-five children received standardized sevoflurane, morphine, vecuronium anaesthesia with either 30% or 80% intraoperative oxygen and no antiemetic prophylaxis in a randomized, double blind, prospective trial. There was no difference in PONV or in the use of rescue ondansetron between the groups. The total incidence of PONV was 40% in the group that received 30% oxygen and 33% in those that received 80% oxygen. High inspired intraoperative oxygen was not found to significantly reduce PONV in well children undergoing dental work under general anaesthesia.     

Analgesic and antiemetic effect of ketorolac vs. betamethasone or dexamethasone after ambulatory surgery

BACKGROUND: Glucocorticoids are known to provide slower onset and more prolonged duration of analgesic effect than ketorolac. In the present study, we wanted to evaluate the effect over time from a single dose of either intravenous (i.v.) dexamethasone or an intramuscular (i.m.) depot formulation of betamethasone compared with i.v. ketorolac. MATERIALS AND METHODS: One hundred and seventy-nine patients admitted for mixed ambulatory surgery were included in the study. After induction of general i.v. anaesthesia, the patients were randomized to receive double-blindly either dexamethasone 4 mg i.v. (Group D) or betamethasone depot formulation 12 mg i.m. (Group B) or ketorolac 30 mg i.v. (Group K). Fentanyl was used for rescue analgesic medication in the post-operative care unit (PACU) and codeine with paracetamol after discharge, for a study period of 3 days. RESULTS: There was significantly less post-operative pain in the ketorolac group during the stay in the unit (88% with minor or less pain in Group K vs. 74% and 67% in Groups D and B, respectively, P < 0.05), significantly less need for rescue medication (P < 0.05) and significantly less nausea or vomiting (12% in Group K vs. 30% in the other groups pooled, P < 0.05). The ketorolac patients were significantly faster for ready discharge, median 165 min vs. 192 min and 203 min in Groups D and B, respectively (P < 0.01). There were no differences between the groups in perceived pain, nausea, vomiting or rescue analgesic consumption in the 4- to 72-h period. CONCLUSION: Dexamethasone 4 mg or bethamethasone 12 mg did not provide prolonged post-operative analgesic effect compared with ketorolac 30 mg, which was superior for analgesia and antiemesis in the PACU.     

Ramosetron versus ondansetron for the prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy

Background  

Patients undergoing general anesthesia for laparoscopic cholecystectomy are at high risk for postoperative nausea and vomiting (PONV). This study compared ramosetron and ondansetron in terms of efficacy for PONV prevention after laparoscopic cholecystectomy.