The Incidence of QT Prolongation and Torsades des Pointes in Patients Receiving Droperidol in an Urban Emergency Department

INTRODUCTION

Droperidol carries a boxed warning from the United States Food and Drug Administration for QT prolongation and torsades des pointes (TdP). After a six-year hiatus, droperidol again became widely available in the US in early 2019. With its return, clinicians must again make decisions regarding the boxed warning. Thus, the objective of this study was to report the incidence of QT prolongation or TdP in patients receiving droperidol in the ED.

METHODS

Patients receiving droperidol at an urban Level I trauma center from 1997-2001 were identified via electronic health record query. All patients were reviewed for cardiac arrest. We reviewed electrocardiogram (ECG) data for both critically-ill and noncritical patients and recorded Bazett's corrected QT intervals (QTc). ECGs from critically-ill patients undergoing resuscitation were further risk-stratified using the QT nomogram.

RESULTS

Of noncritical patients, 15,374 received 18,020 doses of droperidol; 2,431 had an ECG. In patients with ECGs before and after droperidol, the mean QTc was 424.3 milliseconds (ms) (95% confidence interval [CI], 419.7-428.9) before and 427.6 ms (95% CI, 424.3-430.9), after droperidol (n = 170). Regarding critically-ill patients, 1,172 received droperidol and 396 had an ECG. In the critically-ill group with ECGs before and after droperidol mean QTc was 435.7 ms (95% CI, 426.7-444.7) before and 435.8 ms (95% CI, 427.5-444.1) after droperidol (n = 114). Of 337 ECGs suitable for plotting on the QT nomogram, 13 (3.8%) were above the "at-risk" line; 3/136 (2.2%; 95% CI, 0.05-6.3%) in the before group, and 10/202 (4.9%; 95% CI, 2.4%-8.9%) in the after group. A single case of TdP occurred in a patient with multiple risk factors that did not reoccur after a droperidol rechallenge. Thus, the incidence of TdP was 1/16,546 (0.006%; 95% CI, 0.00015 - 0.03367%).

CONCLUSION

We found the incidence of QTc prolongation and TdP in ED patients receiving droperidol to be extremely rare. Our data suggest the FDA "black box warning" is overstated, and that close ECG monitoring is useful only in high-risk patients.

Physicochemical stability of ternary admixtures of butorphanol, ketamine, and droperidol in polyolefin bags for patient-controlled analgesia use

BACKGROUND

Delivery of drug admixtures by intravenous patient-controlled analgesia is a common practice for the management of postoperative pain; however, analytical confirmation of the compatibility and stability of butorphanol tartrate, ketamine hydrochloride, and droperidol combined in ternary admixtures is not available.

METHODS

Butorphanol tartrate, ketamine hydrochloride, and droperidol have been examined for compatibility and stability when combined with 0.9% sodium chloride injection stored at 4°C and 25°C with light protection for a total of 14 days. Concentrations were 0.067 mg/mL, 1.33 mg/mL, and 0.033 mg/mL for butorphanol tartrate, ketamine hydrochloride, and droperidol, respectively. Drug concentrations were determined using high-performance liquid chromatographic analysis.

RESULTS

All three drugs were very stable (>97%) at 4°C and 25°C for 14 days. The ternary admixtures were initially clear and colorless throughout the observation period, and the pH value did not change significantly.

CONCLUSION

The results confirm that the ternary admixture of butorphanol tartrate 0.067 mg/mL, ketamine hydrochloride 1.33 mg/mL, and droperidol 0.033 mg/mL in 0.9% sodium chloride injection were stable for 14 days when stored in polyolefin bags at 4°C and 25°C and protected from light.

Successful protocol of anaesthesia for measuring transepithelial nasal potential difference in spontaneously breathing mice

Numerous difficulties arise during in vivo measurements of transepithelial nasal potential difference (PD) in mice, such as inadequate duration and depth of anaesthesia, bronchoaspiration of solutions perfused in the nose, and respiratory and/or cardiovascular depression.

Anaesthesia was induced in adult C57 mice with intraperitoneal injection of a combination of fentanyl, droperidol and medetomidine, each of these at either a small dose (0.20, 10 and 0.33 mg/kg, respectively) or at a large dose (0.40, 20 and 0.40 mg/kg, respectively), combined with a fixed dose of 0.375 μg clonidine. In order to establish a pharmacokinetic–pharmacodynamic relationship, blood concentrations of the first three drugs were measured in 24 animals by liquid-chromatography tandem mass spectrometry. At the end of the experiment, naloxone, a competitive morphinic antagonist, and atipamezole, an α-2 adrenergic antagonist, were administered. Bronchoaspiration was prevented by tilting the animal head downwards and by absorbing the excess fluid from the opposite nostril and from the oral cavity. Optimal assessment of anaesthesia associated with regular respiration, loss of blink, pupillary and pedal withdrawal reflexes was obtained with doses of fentanyl, droperidol and medetomidine corresponding to 0.20, 20 and 0.40 mg/kg, respectively. Blood concentrations of fentanyl around 17 ng/mL induced loss of respiratory efforts and were followed by death during the experiment. Integrity of ion transport was demonstrated under continuous perfusion by successive depolarization after amiloride and repolarization after chloride-free solution.

The combination investigated in this study lead to adequate surgical anaesthesia (stage III, plane 2) for prolonged nasal PD measurements in spontaneously breathing mice.

[The Effectiveness of Epidural Droperidol for Prophylaxis of Postoperative Nausea and Vomiting: A Comparative Study of Droperidol and Adrenaline]

BACKGROUND

Intravenous droperidol has strong evidence for antiemetic efficacy in high risk patients for prevention of postoperative nausea and vomiting (PONV). However it is not clear whether continuous epidural administration of doroperidol prevent PONV. It has been reported that epidural adrenaline decreases PONV; therefore we prospectively compared the effectiveness of epidural droperidol and adrenaline for prophylaxis of PONV.

METHODS

Eighty-six patients were scheduled for abdominal gynecological surgery under general-epidural anesthesia in the study. Patients were randomly assigned to droperidol group or adrenaline group. We investigated the incidences of PONV, the frequency of using the antiemetics.

RESULTS

There was no statistical difference between the groups. The incidences of PONV were 27.9% (doropeidol group) and 58.1% (adrenaline group), respectively (P = 0.0046). The frequency of the anti-emetics use were 18.6% and 41.9%, respectively (P = 0.0189). There was one patient who needed cancellation of continuous epidural administration for vomiting in adrenaline group, but no patient in doropeidol group.

CONCLUSIONS

The results suggest that epidural droperidol effectively decreases PONV in high risk patients. However epidural adrenaline might be ineffective.

[The Interaction of Low-dose Droperidol, Propofol, and Sevoflurane on QTc Prolongation]

BACKGROUND

Droperidol is an effective antiemetic, but its use is limited because of the warning of drug-induced QT prolongation. Some reports showed that low-dose droperidol does not significantly probing QT interval. This study was aimed to determine the effect of low-dose droperidol (1.25 and 2.5 mg) on QTc interval, and the interaction among droperidol, propofol and sevoflurane.

METHODS

Patients received either 1.25 mg (group L : n = 25) or 2.5 mg (group H : n = 25) droperidol, and fentanyl (3 μg x kg(-1)) was administered 2.5 min later. One minute after fentanyl administration, anesthesia was induced using propofol (1.5 mg x kg(-1)) and vecuronium. One minute after propofol administration, sevoflurane (3%) was started. Tracheal intubation was performed 3 min after propofol administration, and then sevoflurane was reduced to 1%.

RESULTS

Compared to baseline, the QTc interval in group L was unchanged by droperidol. In group H, the QTc interval was significantly prolonged after droperidol injection, but recovered after propofol injection. After tracheal intubation, QTc interval was significantly prolonged in both groups.

CONCLUSIONS

Droperidol's effect on QTc prolongation was shown at the dose of 2.5 mg but not 1.25 mg. This prolongation effect was offset by propofol, and was unchanged by sevoflurane.

Comparison of droperidol and haloperidol for use by paramedics: assessment of safety and effectiveness

BACKGROUND

Since the 2001 "black box" warning on droperidol, its use in the prehospital setting has decreased substantially in favor of haloperidol. There are no studies comparing the prehospital use of either drug. The goal of this study was to compare QTc prolongation, adverse events, and effectiveness of droperidol and haloperidol among a cohort of agitated patients in the prehospital setting.

METHODS

In this institutional review board-approved before and after study, we collected data on 532 patients receiving haloperidol (n = 314) or droperidol (n = 218) between 2007 and 2010. We reviewed emergency department (ED) electrocardiograms when available (haloperidol, n = 78, 25%; droperidol, n = 178, 76%) for QTc length (in milliseconds), medical records for clinically relevant adverse events (defined a priori as systolic blood pressure (SBP) <90 mmHg, seizure, administration of anti-dysrhythmic medications, cardioversion or defibrillation, bag-valve-mask ventilation, intubation, cardiopulmonary arrest, and prehospital or in-hospital death). We also compared effectiveness of the medications, using administration of additional sedating medications within 30 minutes of ED arrival as a proxy for effectiveness.

RESULTS

The mean haloperidol dose was 7.9 mg (median 10 mg, range 4-20 mg). The mean droperidol dose was 2.9 mg (median 2.5 mg, range 1.25-10 mg.) Haloperidol was given i.m. in 289 cases (92%), and droperidol was given i.m. in 132 cases (61%); in all other cases, the medication was given i.v.. There was no statistically significant difference in median QTc after medication administration (haloperidol 447 ms, 95% CI: 440-454 ms; droperidol 454 ms, 95% CI: 450-457). There were no statistically significant differences in adverse events in the droperidol group as compared to the haloperidol group. One patient in the droperidol group with a history of congenital heart disease suffered a cardiopulmonary arrest and was resuscitated with neurologically intact survival. There was no significant difference in the use of additional sedating medications within 30 minutes of ED arrival after receiving droperidol (2.9%, 95% CI: -2.5-8.4%).

CONCLUSIONS

In this cohort of agitated patients treated with haloperidol or droperidol in the prehospital setting, there was no significant difference found in QTc prolongation, adverse events, or need for repeat sedation between haloperidol and droperidol.

[Prophylaxis of intraoperative nausea, vomiting and abdominal discomfort due to spinal anaesthesia for caesarian operation]

The article deals with data of comparison of different antiemetic drugs used for prophylactics of intraoperative nausea and vomiting (IONV) during caesarian operation. 150 women included in the study were divided into three groups. Patients of the group-1 (80 women) received dproperidol 0.08-0.12 mg kg(-1) intravenously and atropine 0.006-0.009 mg kg(-1). Patients of the group-2 (50 women) received dexamethasone 0.04-0.1 mg kg(-1) intravenously. In the group-3 (20 women) patients received methoklopramide 0.1-0.2 mg kg(-1) intravenously. Intravenous administration of low doses of atropine and dproperidol provides the most effective prophylactics of IONV.

[Influence of acupoint injection with small dose of fentanyl-droperidol mixed liquor on labor analgesia and level of stress hormone in parturient]

OBJECTIVE

To observe the clinical effect of acupoint injection with small dose of fentanyl-droperido mixed liquor at different time stages on labor analgesia, and explore its function mechanism.

METHODS

One hundred and fifty cases of full-term primiparas who were intended to take vaginal delivery were randomly divided into 3 groups, 50 cases in each one. The acupoint injection with fentanyl-droperido mixed liquor at different time stages was applied in the group I, where Shenshu (BL 23) was selected in active phase and Ciliao (BL 32) was selected in the 2nd stage of labor. The subcutaneous injection with fentanyl-droperido mixed liquor was adopted in group II. The group III, which was considered as a control group, was treated with subcutaneous injection of 0.9% NaCl at the same time stage as group I and II. The blood pressure, VAS score and level of norepinephrine and adrenaline were observed at different time stages.

RESULTS

Compared before the injection, the blood pressure of group III in the active phase and 2nd stage of labor was significantly increased (P < 0.05), and that in group II and III was obviously higher than that in the group I (P < 0.05). The VAS score of group I in the active phase and 2nd stage of labor was significantly lower than that in the group II and III (P < 0.01). After the injection, the level of NE and E was significantly decreased (P < 0.05), which was lower than that in the group II and III (P < 0.05).

CONCLUSION

The acupoint injection with small dose of fentanyl-droperido mixed liquor at different time stages has positive effect on labor analgesia, and it could significantly relieve stress reaction of parturient during the labor. Its mechanism could be related to the reduction of stress hormone in parturient.

[Extrapyramidal reactions in three patients due to droperidol infusion for intravenous patient-controlled analgesia]

Intravenous patient-controlled analgesia (iv-PCA) has a great advantage for pain control in the postoperative period with occasional disadvantages of postoperative nausea and vomiting, which should be treated appropriately. Droperidol is commonly used as anti-emetic drug, but it also has a potential risk to induce extrapyramidal reactions. We report three patients who showed extrapyramidal reactions among 589 patients after droperidol administration. Although this complication is rare, we should be aware of the possible extrapyramidal reactions due to droperidol.

Long-term use of intrathecal droperidol as an excellent antiemetic in nonmalignant pain--a retrospective study

Over the past five years our pain practice encountered eight patients (5 female, 3 male) with chronic non-malignant pain syndromes, in whom any meaningful pain reduction via opioid analgesics (either by oral or systemic and/or intraspinal route) had resulted in profound nausea and/or vomiting despite generous use of available and/or affordable anti-emetics. After obtaining proper consents, small, incremental doses of intrathecal droperidol were added to these patients having implanted intrathecal narcotic drug delivery system. Significant reduction of nausea and vomiting without any side effects from droperidol was obtained while adequate pain reduction is achieved.

PROCEDURE

All patients had implanted programmable Medtronic Synchromed pumps with intrathecal access catheters. The intrathecal catheter tip placement varied depending on the pain pathology of the patient. Six of eight patients were started and remained on morphine sulfate intrathecally for their opioids. Two patients with contraindications to morphine had fentanyl and hydramorphone as their intrathecal opioid respectively. The intrathecal dose of droperidol was started low (22.7 +/- 18.6 micrograms/day). All patients were on simple continuous pump dosing during the study.

RESULTS

All patients achieved statistically significant antiemesis (77 +/- 10% P < 0.001) as well as statistically significant pain relief (84 +/- 7% P < 0.005) early on (within two pump refills). As the intrathecal dose/day of droperidol was increased to 124.7 +/- 114.8 micrograms/day as well as their intrathecal pain medication use, the degree of significance of antiemesis improved to 86 +/- 9% (P < .001) which was a statistically significant improvement of P < or = 0.05 level from the starting dose of droperidol in each patient. For the six patients on morphine the antiemesis improved to 88 +/- 10% (P < or = .003), also statistically significantly different at P < or = 0.05 level from the starting antiemesis level. During this period the intrathecal morphine dose was doubled from 4.76 +/- 2.43 mg/day to 9.5 +/- 6.5 mg/day (P < or = .001). Patients had no adverse effects from the use of droperidol at these doses (no sedation, changes in mental status, no signs or symptoms of arachnoiditis, no new sensory or motor disturbance, or any other indications of nerve toxicity detected.). Serial neurological studies involving MRI and CT, with contrast, EMG every 6-12 month showed no intrathecal catheter tip irritation sequelae in our patients either.

CONCLUSIONS

We find droperidol in microgram doses of 5-300/day intrathecally a safe antiemetic to use along with opioid analgesics. We did not use droperidol intrathecally alone as its use systemically without an opioid companion base is fraught with concern in anesthesia literature ("calm looking on the outside-agitated on the inside"). We would suggest a minimal starting dose of 20-30 micrograms/day of droperidol, adjust most probably upwards by 25-50% on subsequent pump refills until the desired effect is established. The scientific literature is rich with references to the brainstem chemoreceptor trigger zone, the floor of the fourth ventricle, and other nausea center locations (area postrema, the circumventricular organ, etc.). We would like to suggest that droperidol's direct actions on these centers are involved with antiemesis at these small doses.

[Dyskinesia after treatment with droperidol for preventing postoperative nausea and vomiting]

This case presents a young woman with extrapyramidal reactions after the use of a small dose (0.625 mg) of droperidol. In combination with dexamethason (8 mg) droperidol was given as the patient underwent laparoscopic cholecystectomy in order to prevent postoperative nausea and vomiting. The patient presented characteristic signs of ataxia. The signs lasted for 36 hours. We believe that droperidol was the cause. She had previously experienced similar signs after taking metoclopramide.

To add or not to add? An empirical study on droperidol and intravenous patient-controlled analgesia

BACKGROUND

Droperidol is commonly added to intravenous patient-controlled analgesia (IVPCA) regimens as an antiemetic agent. Although some studies have demonstrated its safety and efficacy, it is not clear whether adding droperidol to IVPCA infusate without an extra loading dose can effectively reduce the incidence and severity of postoperative nausea and vomiting (PONV) in real-life clinical settings.

METHODS

Patients receiving IVPCA in this retrospective survey were classified into two groups based on their IVPCA regimens. The droperidol group used morphine 1mg/mL with droperidol 50 μg/mL, and the non-droperidol group was given morphine 1 mg/mL alone. The incidence and severity of PONV were compared between the two groups during the 3-day course of IVPCA treatment using logistic regression and ordinal logistic regression. Propensity score methodology was applied to adjust for potential confounders.

RESULTS

Among the 186 patients enrolled, 94 patients received IVPCA with droperidol, and 92 patients received a pure morphine solution. There was no significant difference in patient attributes between the two groups. On the 1st postoperative day, there was no significant difference in incidence or severity of PONV between the two groups. From the 2nd day onward, the patients in the droperidol group had significantly fewer and less severe episodes of PONV (relative risk 0.34 and 0.31, respectively). The overall effects of droperidol on PONV and its severity during the whole IVPCA course were also statistically significant, whether or not adjustment for propensity score was made. However, although a statistically significant decrease in nausea was observed in the droperidol group after the 1st day, no significant difference in the incidence of vomiting between the two groups was noted during the study.

CONCLUSION

A loading dose should be considered on the 1st postoperative day. Our study suggests just how beneficial droperidol can be to IVPCA users in practical clinical settings, showing that droperidol can reduce with some significance the amount and severity of nausea suffered by patients postoperatively, even if the frequency of patient vomiting remains unchanged.

[Evaluation of the side effects of intravenous patient controlled analgesia after spine surgery]

BACKGROUND

We have adopted intrravenous patient controlled analgesia (IV-PCA) for spine surgery. We could not find reports about detailed examinations of the side effects of IV-PCA using morphine after spine surgery, so we investigated retrospectively side effects in cases using morphine IV-PCA.

METHODS

Eighty-five patients underwent IV-PCA after spine surgery. The contents of PCA pump were morphine 20 mg (= 2 ml), droperidol 2 mg (= 0.8 ml), and saline 77 ml. We fixed continuous infusion at 2 ml x hr(-1), bolus infusion at 2 ml x hr(-1), and lockout time at 15 minutes. Respiration time, SpO2, blood pressure, pulse rate, nausea and vomiting, and VAS were monitored while IV-PCA was in use. When severe side effects were noticed, IV-PCA was discontinued by physician in charge. We judged discontinuation of IV-PCA as occurrence of severe side effects.

RESULTS

IV-PCA was discontinued in seven patients. The causes of discontinuation were nausea and vomiting, hypotension, and bradycardia. Nausea and vomiting was the most common cause and found mostly in women.

CONCLUSIONS

Because IV-PCA was discontinuated in 8.2% of patients, it was thought that its management depending on patients' personal state was necessary to utilize IV-PCA as a method of postoperative analgesia.

[Intravenous patient-controlled analgesia (IV-PCA) for relief of postoperative pain]

Intravenous patient-controlled analgesia (IV-PCA) using opioids such as morphine and fentanyl can be an effective analgesic method for post-operative pain that is resistant to conventional administration of narcotic analgesics and nonsteroidal anti-inflammatory drugs, and where epidural block and peripheral nerve block are not feasible. In addition to post-operative pain relief, IV-PCA can facilitate early ambulation, reduce respiratory complications, and increase patient satis-faction. However, respiratory and circulatory depression, and post-operative nausea and vomiting (PONV) often occur as side effects of IV-PCA with opioids. Administration of droperidol can be an effective treatment for PON.

[Effectiveness of low dose PCEA for postoperative pain after laparoscopic gynecological surgeries--a comparison of laparoscopic ovarian cystectomy and myomectomy]

BACKGROUND

We evaluated the effectiveness of low-dose patient-controlled epidural analgesia (PCEA) in the patients undergoing laparoscopic gynecological surgery, and investigated the difference of postoperative pain between patients for laparoscopic ovarian cystectomy and those for myomectomy.

METHODS

Thirteen patients (ASA PS 1 or 2), scheduled for laparoscopic surgery, were enrolled in this study. They were divided into two groups of ovarian cystectomy (group C, n=17) and myomectomy (group M, n=13). After administering epidural bolus of 0.2% ropivacaine 6 ml, droperidol 2.5 mg, and buprenorphine hydrochloride 0.1 mg, PCEA was started: 1 ml x hr(-1) background infusion; 0.2% ropivacaine 54 ml, droperidol 5 mg, and buprenorphine hydrochloride 0.3 mg; 1 ml epidural bolus with a 30-minute lockout interval. We evaluated postoperative pain using visual analogue scale (VAS) at rest and on movement, adverse effects such as respiratory and cardiovascular depression, nausea and vomiting for 48 hours after surgery.

RESULTS

VAS at rest with group M was significantly higher than that of group C (11 +/- 2 vs. 6 +/- 2, P=0.048), and VAS on movement of group M was also higher than that of group C (25 +/- 3 vs. 18 +/- 2, P=0.023): however, we found good analgesic effect of less than VAS 3 in both groups. Severe adverse effects were not observed.

CONCLUSIONS

These findings suggest that low dose PCEA is effective for patients who undergo laparoscopic gynecological surgery.

[Control of postoperative nausea and vomiting by preventive administration of dexamethasone]

BACKGROUND

Postoperative nausea and vomiting (PONV) are the most frequent side effects after anesthesia. Patients with persistent PONV continue to be impaired in performing their normal daily activities. We studied the controlling effect of dexamethasone (4 mg) before the induction of general anesthesia in the prevention of PONV.

METHODS

Ninety-one patients were divided into respiratory surgery group (dexamethasone N=22, none N=23) and gynecology group (dexamethasone N=22, none N=24), respectively. Dexamethasone group received dexamethasone 4 mg before the induction of general anesthesia. PONV and antiemetic requirements were recorded.

RESULTS

In the dexamethasone group (respiratory surgery, gynecology), the incidences of PONV during the initial 24 hour postoperative period were 36.4% (N=8), and 18.2% (N=4), respectively. In the none group, the incidences were 43.5% (N=10), and 41.7% (N=10), respectively Antiemetic requirements were 22.7% (N=5), 9.1% (N=2), 39.1% (N=9), and 20.1% (N=5), respectively (NS). In gynecology group, in almost all the patients droperidol was used in epidural anesthesia. Combination of dexamethasone and droperidol may have greater antiemetic action than a single drug.

CONCLUSIONS

Combination therapy with dexamethasone and droperidol may reduce PONV in patients undergoing surgery.

Discomfort, delirium, and PONV in infants and young children undergoing strabismus surgery

This article presents the results of a retrospective analysis of anesthesia care and perioperative outcomes in children up to 2 years of age who underwent strabismus surgery during a five-year period at the University of Minnesota Amplatz Children's Hospital. We reviewed the charts of 74 children to determine perioperative outcomes--namely discomfort, emergence agitation/delirium, and postoperative nausea and vomiting (PONV).We found that although PONV was not an issue in this age group, as it was with older children, discomfort and emergence agitation/delirium do need to be considered during their care.

[Preoperative intravenous administration of droperidol (1.25 mg) reduced postoperative nausea and vomiting after intrathecal morphine administration]

BACKGROUND

Intrathecal morphine (ITM) is an excellent postoperative analgesic, but may often cause postoperative nausea and vomiting (PONV). We designed this prospective, randomized and controlled study to evaluate the antiemetic efficacy of low-dose droperidol for the treatment of PONV caused by ITM.

METHODS

Two hundred female patients undergoing elective total hip arthroplasty were enrolled. They received spinal anesthesia with isobaric bupivacaine and 0.08 mg ITM, and 100 patients were randomly administered with 1.25 mg droperidol intravenously before operation. We observed the incidence of PONY and pain score until 24 hr after operation, and investigated the doses of anti-hypotensive drugs (ephedrine and phenylephrine) and fluid administered intraoperatively.

RESULTS

The incidence of PONV was lower in the droperidol group within 6 hr after operation (control group 47%, droperidol group 15%), and especially lower within 2 hr (43% vs. 3%), but was not different 6 hr after operation. The pain score was very low throughout the observation period in both groups and especially within 12 hr. The respective doses of the anti-hypotensive drugs and fluid administered intraoperatively during the operation were higher in the droperidol group. Severe arrhythmia was not observed in any patient throughout the observation period.

CONCLUSIONS

Single intravenous administration of 1.25 mg droperidol before operation showed prophylactic efficacy in early PONV caused by ITM. The duration of droperidol action was shorter than that of ITM. Hence we recommend that droperidol should be administered more frequently or continuously in the postoperative period.

Comparison the effects of metoclopramide and dropridol associated with dexamethasone on post operative nausea and vomiting

The aim of study was, comparison of effects of Metoclopramide and Dropridol associated with Dexamethasone on prevalence of nausea and vomiting after operation was considered. In this study 160 patients ASA physical status I were divided into two groups. In both groups, premedication and induction of anesthesia were given equally according to weight. To the first group, Metoclopramide associated with Dexamethasone and to the second group, Dropridol associated with Dexamethasone was ordered. At the end of the operation, after removing tracheal tube, prevalence of nausea and vomiting in both groups was considered after 2 h and results were analyzed with t-test and Chi-square. Ratio of nausea and vomiting after operation in the first group was 24% and in the second 8%. So results show that prevalence of nausea and vomiting in the second group was considerably lower than the first group (p < 0.004). According to the results of this study our conclusion, Dropridol with dexamethasone given at the before of general anesthesia was more effective in decreasing the prevalence of nausea and vomiting in patients compared with metoclopramide with dexamethasone.

[Case of acute dystonia during epidural droperidol infusion to prevent postoperative nausea and vomiting]

We report a case of bilateral ocular deviation due to droperidol-induced acute dystonia that was initially undiagnosed. A 22-year-old, 72 kg, parturient at 42 weeks' gestation underwent emergency cesarean section for pregnancy-induced hypertension under combined spinal-epidural analgesia. The epidural catheter was inserted through the T11-12 interspace, followed by intrathecal hyperbaric bupivacaine with adjunctive fentanyl. The patient complained of nausea shortly after delivery, which subsided with intravenous droperidol 1.25 mg and metoclopramide 10 mg. After surgery, epidural infusion with a mixture of ropivacaine, fentanyl, and droperidol was started. Around 25 hours postoperatively, both of the patient's eyes rotated upwards, although she was fully conscious. Brain CT/MRI did not show any abnormalities. An ophthalmologist and a neurosurgeon were consulted but there was no definitive diagnosis. On subsequent consultation with anesthesiologists, it was assumed that the symptom was related to external ophthalmoplegia secondary to spinal anesthesia. Thereafter, a "wait and see" approach was adopted. After 8 hours, she gradually developed torticollis and increased muscle tone of the lower extremities, which facilitated a diagnosis based on extrapyramidal signs. Epidural infusion was discontinued without further treatment. Her symptoms completely disappeared within 5 hours. The estimated cumulative dose of intravenous and epidural droperidol was 4.6 mg over 34 hours.

[Preventive effect of acupoint injection at neiguan (PC 6) on postoperative nausea and vomiting after laparoscopic gynecologic surgery]

OBJECTIVE

To investigate the method for preventing the postoperative nausea and vomiting (PONV) after laparoscopic gynecologic surgery.

METHODS

One hundred and twenty patients being for laparoscopic gynecologic surgery at I- II grade as American Society of anesthesiologists (ASA) were randomly divided into three groups, 40 cases in each group. Twenty minutes before the operation, the mixture of 2. 5 mg Droperidol (1 mL) and 1 mL 0. 9% sodium chloride solution was injected into the bilateral Neiguan (PC 6) in group I , and an intravenous injection with 1 mL Droperidol was used in group II , while there was no treatment carried out in group Ill'. Twenty four hours after the operation, the frequency and degree of nausea and vomiting were observed and scored according to the criteria standard.

RESULTS

The incidence rate of nausea was 10. 0% (4/40) in group I , 57. 5% (23/40) in group II , which was significantly different from 80. 0% (32/40) in group III (P<0. 01, P<0. 05, respectively), while it was lower in group I than in group II (P<0. 01). The incidence rate of vomiting was 7. 5% (3/40) in group I , 52. 5% (21/40) in group II , which was significantly different from 75.0% (30/40) in group III (P<0.01, P<0.05 respectively), while it was lower in group I than in group II (P<0.01). No complication, such as obvious drowsiness, anxiety and extracorticospinal tract reaction, was observed among the three groups.

CONCLUSION

Acupoint injection at Neiguan (PC 6) with a small dose of Droperidol can effectively prevent the PONV after laparoscopic gynecologic surgery without other adverse effects.