European Society of Anaesthesiologists; 8th Annual Meeting with the Austrian International Congress; Vienna, Austria, 1-4 April 2000
Background and goal of study: This study compares the effectiveness of traditional antiemetics (i.e. droperidol and metoclopramide) vs traditional antiemetics enhanced with dexamethasone vs multifactorial treatment (i.e. droperidol plus metoclopramide plus dexamethasone plus ondansetron). The purpose is to achieve a cheap and good method of eliminating PONV in patients with known motion sickness scheduled for gynaecological laparoscopic surgery .
Materials and methods: With approval of the local ethics committee 600 ASA I and II patients with motion sickness in anamnesis and at least 2 incidents of PONV after previous anaesthetic procedures scheduled for laparoscopy received a standardized general anaesthesia (induction with propofol, fentanyl and succinylcholine after 3 min oxygenation, 66% nitrous oxide in oxygen, sevoflurane, vecuronium; IPPV supplied patients with 10 mL kg−1 of tidal volume via endotracheal tube). All patients who had episodes of PONV after emergence from anaesthesia were blindly randomized to be given i.v. either droperidol 1.25 mg + metodopramide 10 mg (group 1), or droperidol, metoclopramide and dexamethasone and ondansetron 8 mg (group 3). The patients were followed up for emetic symptoms for 24 h. Data were analysed using χ2 test, the Kaplan-Meier method of estimating probability of remaining PONV-free, and the logrank test.
Results: The demographic parameters were similar between the groups. TABLE
As all the known drugs reduce but do not eliminate incidence of PONV, the synergistic, multifactorial treatment appears to be highly effective and not accidental (P<0.001), although the mechanism of the action remains unknown.
Conclusions: Treatment of PONV can proceed gradually. The quite satisfactory effect can be observed after IV administration of dexamethasone following IV droperidol and metoclopramide. The additional administration of ondansetron 8 mg IV actually eliminates PONV.
1 Zając K, Zając M. Acta Anaesthesiol Scand
2 Zając K, Zając M, et al. Br J Anaesth
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Epidemiology in anaesthesia and intensive care