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Abstract
Postoperative nausea and vomiting (PONV) continues to be the most common complication after anesthesia and surgery. Several drugs and techniques have been used to reduce the incidence of PONV. Patients undergoing laparoscopic cholecystctomy are at high risk for PONV. These are frequently the case of great distress to patients and it is often the worst memory of their hospital stay.
The consequences of prolonged PONV range from unexpected admission of day case surgical patients, to physical, metabolic and psychological effects on the patients which slow their recovery and reduce their confidence in future surgery and anesthesia. Persistent nausea and vomiting may result in dehydration, electrolyte imbalance and delayed discharge. Persistent retching or vomiting can cause tension on suture lines, venous hypertension and increased bleeding under skin flaps and can expose the subject to an increased risk of pulmonary aspiration of vomitus if airway reflexes are depressed from the residual effects of anesthetic and analgesic drugs.
The aim of this work was to compare between haloperidol, ondansetron and midazolam for the prevention of postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy.
This study was carried out on forty five female patients (ASAI, ASAII), admitted to Alexandria Main University Hospital undergoing laparoscopic cholecystectomy. Patients were randomly allocated into 3 equal groups using the closed envelope technique.
Exclusion criteria were patient’s refusal to participate in the study, previous history of PONV and travel sickness, pregnancy, obesity, body mass index > 30 Kg.m -2 , consumption of an agent with antiemetic properties within 24hr prior to the study, previous gastrointestinal problems and past history of head injury.
Before surgery all patients were assessed by careful history taking, clinical evaluation and standard laboratory investigations. Half an hour before anesthesia, patients were received orally one of the following drugs:
Patients of group I: received 5 mg haloperidol.
Patients of group II: received 4mg ondansetron.
Patients of group III: received 7.5 mg midazolam.
This dose was repeated every 8 hours.
All patients received the same standard anesthetic technique, in the form of fentanyl (2µg/kg) and propofol (2-3mg/kg). Atracurium (0.5mg/kg) was used to facilitate endotracheal. Anesthesia was maintained using isofurane 1-2% in oxygen and patients were mechanically ventilated. Fentanyl and atracurim increments were given as required. All patients received 60 mg ketorolac intramuscularly (IM) as a preventive analgesia immediately postoperative.
The following parameters were assessed in the present study; heart rate (beats/min), mean arterial blood pressure (mmHg), respiratory rate (breaths/min), nausea scoring, vomiting scoring, postoperative pain scoring using (VAS), assessment of sedation using sedation five point scale and the need for rescue antiemetic drug were recorded.