NEW THERAPEUTIC STRATEGIES IN TREATMENT OF POSTOPERATIVE NAUSEA AND VOMITING
Keywords:
anxiety, midazolam, postoperative nausea and vomitingAbstract
Background. If untreated, one third of patients who undergo surgery develop postoperative nausea and/or vomiting (PONV). The prevention of postoperative nausea and vomiting can improve satisfaction among vulnerable patients. We hypothesized that preoperative anxiety may increase the incidence of PONV. The objective was to assess whether administration of a benzodiazepine prior to surgery would reduce the incidence of PONV. Methods. 130 women (ASA I and II) scheduled to undergo dilatation and curettage comprised the study group. The women were allocated randomly to two study groups according to the type of anesthesia administered (with and without midazolam). Results. Sixty-eight women received midazolam and 62 did not. Patients treated with midazolam were feeling more comfortable (“Friendliness”, p=0.005 and “Elation”, p=0.01) and had less postoperative fatigue (p=0.04) than non-midazolamtreated group. Patients treated with midazolam had significantly fewer emetic episodes during the first 4 hours after surgery than those without midazolam (0.1±0.2 vs. 0.3±0.6, respectively, p=0.003). Conclusions. Midazolam reduces the incidence of PONV and improves patient’s comfort. We suggest that midazolam be routinely included in the anesthesia protocol for short-term gynecological procedures (dilatation and curettage).
References
Cost-effectiveness of prophylactic antiemetic therapy with ondansetron, droperidol, or placebo / R. P. Hill, D. A. Lubarsky, B. Phillips-Bute [et al.] // Anesthesiology. – 2000. – Vol. 92. –P. 958–967.
A factorial trial of six interventions for the prevention of postoperative nausea and vomiting / C. C. Apfel, K. Korttila, M. Abdalla [et al.] // N Engl J Med. – 2004. – Vol. 350. – P. 2441–2451.
Watcha M. F. The cost-effective management of postoperative nausea and vomiting / M. F. Watcha // Anesthesiology. – 2000. – Vol. 92. – P. 931–933.
Difference in risk factors for postoperative nausea and vomiting / M. Stadler, F. Bardiau, L. Seidel [et al.] // Anesthesiology. – 2003. – Vol. 98. – P. 46–52.
Society for Ambulatory Anesthesia guidelines for the management of postoperative nausea and vomitin / T. J. Gan, T. A. Meyer, C. C. Apfel [et al.] // Anesth Analg. – 2007. – Vol. 105. – P. 1615–1628.
Evaluation of three risk scores to predict postoperative nausea and vomiting / L. H. Eberhart, J. Hogel, W. Seeling [et al.] // Acta Anaesthesiol Scand. – 2000. – Vol. 44. – P. 480–488.
The comparative study to evaluate the effect of palonosetron monotherapy versus palonosetron with dexamethasone combination therapy for prevention of postoperative nausea and vomiting / J. W. Park, J. W. Jun, Y. H. Lim [et al.] // Korean J Anesthesiol. – 2012. – Vol. 63, N 4. – P. 334–339.
D’souza N. Comparative study of dexamethasone and ondansetron for prophylaxis of postoperative nausea and vomiting in laparoscopic gynecologic surgery / N. D’souza, M. Swami, S. Bhagwat // International Journal of Gynecology and Obstetrics. – 2011. – Vol. 113. – P. 124 – 127.
Day surgery in Australia: Quantitative research report / M. Marcovic, M. Bandyopadhyay, L. Manderson [et al.] // Journal of Sociology. – 2004. – Vol. 40. – P. 74–84.
Trends in day surgery rates / P. Aylin, S. Williams, B. Jarman, A. Bottle // BMJ. – 2005. – Vol. 331. – P. 803.
Implications of antenatal depression and anxiety for obstetric outcome / L. Andersson, I. Sundstrom-Poromaa, M. Wulff [et al.] // Obstet Gynecol. – 2004. – Vol. 104. – P. 467–476.
Wang S. M. Preoperative anxiety and postoperative nausea and vomiting in children: is there an association? / S. M. Wang, Z. N. Kain // Anesth Analg. – 2000. – Vol. 90. – P. 571–575.
Preoperative intravenous midazolam: benefits beyond anxiolysis / K. P. Bauer, P. M. Dom, A. M. Ramirez, J. E. O’Flaherty // J Clin Anesth. – 2004. – Vol. 16. – P. 177–183.
