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

Erken dönem civciv embriyo modelinde dimenhidrinatın nöral tüp gelişimi üzerine etkisi

Amaç: Bu çalışmada dimenhidrinat’ın erken dönem civciv embriyo modelinde nöral tüp gelişimi üzerindeki etkilerinin araştırılması amaçlanmıştır. Gereç ve Yöntem: Çalışmada 32 fertil, spesifik patojen olmayan yumurta kullanıldı. Tüm yumurtalar her bir grupta 8 adet olacak şekilde dört gruba ayrıldı. İnkübasyonun 28. saatinde deney gruplarına üç farklı dozda (0,7, 1,4, 2,1 mg/kg) dimenhidrinat ve kontrol grubuna serum fizyolojik enjekte edildi. İnkübasyonun 48. saatinde tüm embriyolar diseke edildi ve ışık mikroskobu altında histolojik olarak değerlendirildi. Bulgular: Kontrol, düşük, orta ve yüksek doz grubu embriyoları morfolojik olarak değerlendirildiğinde, kraniokaudal uzunluk ortalamaları sırasıyla; 8493,73±1342,90 µm, 5743,61±770,3 µm, 5572,62±315,32 µm, 5306,55±1135,99 µm, somit sayıları ortalamaları sırasıyla; 15,91±1,62, 15,38±1,19, 15,13±0,83, 10,63±5,15‘dir. Dimenhidrinat dozundaki artışa bağlı olarak kraniokaudal uzunluklarının ve somit sayılarının azaldığı tespit edildi. Dimenhidrinat doz artışına bağlı olarak nöral tüp açıklığının arttığı belirlendi . Sonuç: Bu çalışmada, erken dönem civciv embriyo modelinde dimenhidrinat uygulanan gruplarda doz artışına bağlı olarak nörogenezisin ve morfolojik gelişimin olumsuz etkilendiği görüldü.

Comparison of dexamethasone, metoclopramide, and their combination in the prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy

BACKGROUND

Postoperative nausea and vomiting (PONV) are one of the most common complaints following anesthesia and surgery. This study was designed to evaluate the efficacy of dexamethasone, metoclopramide, and their combination to prevent PONV in patients undergoing laparoscopic cholecystectomy.

METHODS

A total of 160 ASA physical status I and II patients were included in this randomized, double blind, placebo-controlled study. Patients were randomly assigned to 4 groups (n = 40 each): group 1 consisting of control patients administered 0.9% NaCl; group 2 patients received metoclopramide 10 mg just before the end of anesthesia; group 3 patients received dexamethasone 8 mg after the induction of anesthesia; and group 4 patients received dexamethasone 8 mg after the induction of anesthesia and metoclopramide 10 mg before the end of anesthesia. The incidence of PONV, mean visual analog pain scores at rest and on movement, time to the first request for analgesia, side effects, and well-being score were recorded during the first 24 h postoperatively.

RESULTS

Data were analyzed using one-way analysis of variance (ANOVA) and the chi2 test, with p < 0.05 considered statistically significant. The total incidence of PONV was 60% with placebo, 45% with metoclopramide, 23% with dexamethasone, and 13% with the combination of dexamethasone plus metoclopramide. None of the dexamethasone plus metoclopramide group patients (p < 0.05 versus groups 1 and 2) and one dexamethasone group patient (p < 0.05 versus group 1) required antiemetic rescue, as compared with four patients in the metoclopramide group and six patients in the placebo group. Pain scores, the time to the first request for analgesia, and side effects were similar across the study groups.

CONCLUSIONS

Dexamethasone and the combination of dexamethasone plus metoclopramide were more effective in preventing PONV than metoclopramide and placebo.

Prophylactic Antiemetics for Laparoscopic Cholecystectomy: Droperidol, Metoclopramide, and Droperidol plus Metoclopramide

BACKGROUND

Postoperative nausea and vomiting (PONV) is one of the most significant problems in laparoscopic surgery. The antiemetic effects of metoclopramide and droperidol used alone or in combination for prevention of PONV after laparoscopic cholecystectomy (LC) were assessed in this prospective, double blind, placebo controlled randomized study.

PATIENTS AND METHODS

A series of 140 patients, ASA physical status I or II, were included in the study. Patients were randomized to one of the following groups: 1, placebo; 2, metoclopramide 10 mg after the induction of anesthesia and placebo at 12 h postoperatively; 3, droperidol 1.25 mg after the induction of anesthesia and droperidol 1.25 mg at 12 h postoperatively; and 4, droperidol 1.25 mg plus metoclopramide 10 mg after the induction of anesthesia and droperidol 1.25 mg at 12 h postoperatively. Patients were observed for 24 hours for PONV, pain, need for rescue analgesics, and adverse events.

RESULTS

Data were analyzed using the Student's t-test and chi-square test, with P < 0.05 considered statistically significant. The mean incidence of PONV was 54% with placebo, 42% with metoclopramide, 14% with two doses of droperidol alone, and 11% with a combination of metoclopramide plus droperidol. The patients receiving a combination of metoclopramide and droperidol had a significantly lower rate of PONV than those administered metoclopramide alone (P < 0.05) or placebo (P < 0.001). Those receiving two-dose droperidol alone also had a significantly lower incidence of PONV compared with metoclopramide (P < 0.05) and placebo (P < 0.001). There was no statistically significant difference between the metoclopramide and placebo groups. Sedation was significantly greater in patients administered droperidol 12 h postoperatively.

CONCLUSION

The combination of metoclopramide and droperidol, and two-dose droperidol alone, were found to significantly decrease the incidence of PONV after LC, whereas metoclopramide alone proved inefficient.