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Ambulatory Anaesthesia

Dexamethasone - a good choice for PONV prevention in ENT surgery


Cucereanu-Badica, I.; Bradis, A. A.; Grintescu, I.

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European Journal of Anaesthesiology (EJA): June 2006 - Volume 23 - Issue - p 15
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Background and Goal of Study: ENT surgery is associated with a high incidence of 24 hours PONV that affects the length of hospitalization. The aim of this study was to investigate the efficacy of PONV profilaxis with 8 mg Dexamethasone or 4 mg Ondansetron and the best treatment of PONV.

Materials and Methods: after Hospital Ethics Committee approval 180 adult patients undergoing ENT surgery were randomized in 3 groups each of 60 patients. In the first group (P) we administrated placebo (saline), in the second (D) 8mg Dexamethasone and in the third (O) 4mg Ondansetron, all given 15 minutes preoperatively. When PONV appeared (42 patients) we randomly administrated 4mg Dexamethasone to 21 patients and 4mg Ondansetron to 21 patients. We evaluated the incidence of PONV in these 3 different groups, the response to treatment at patients in whom PONV occurs and the necessity to postpone discharge for PONV. Statistics used: Student's test, Fisher's exact test (p < 0.05).

Results and Discussions: No significant difference was found between O and D group (PONV incidence 15% in group D vs. 16.7% in group O) (p ≈ 1); but for patients who underwent septoplasty and rhinoplasty intervention (28 from group D and 26 from group O) Dexamethasone was superior than Ondansetron in preventing PONV (PONV incidence 14.7% vs. 23%) even not statistically significant (p = 0.49). The incidence of PONV in P group 38.33% was significantly higher than in the other 2 groups (p = 0.0067, p = 0.01). For treatment of PONV 4mg Ondansetron was better (71.5% responded to treatment and could be discharged) than 4 mg Dexamethasone (9.5% responders to treatment) (p = 0.0058). From those patients in whom PONV occurred, those treated with Ondansetron spent less time in hospital: 14.57 ± 6.3h compared with those treated with Dexamethasone 21.33 ± 5.97h.

Conclusion(s): Profilaxis of PONV with 8mg Dexamethasone is efficient and nonexpensive, so we strongly recommend it in ENT surgery and especially in septo- and rhinoplasty. When PONV occurs Dexamethasone is not recommended for treatment.

© 2006 European Society of Anaesthesiology