scholarly journals Stress response and state of cognitive functions in the perioperative period in elderly patients during laparoscopic cholecystectomy

2021 ◽  
pp. 34-39
Author(s):  
Olena Bielykh ◽  
Marine Georgiyants ◽  
Olena Vysotska ◽  
Anna Strashnenko
Keyword(s):  
Mechanical Ventilation ◽  
Laparoscopic Cholecystectomy ◽  
Elderly Patients ◽  
Cognitive Functions ◽  
Perioperative Period ◽  
The State ◽  
Stress Markers ◽  
Group I ◽  
Baseline Values ◽  
Group Ii

The aim. To investigate the dynamics of stress markers and the state of cognitive functions in the perioperative period during laparoscopic cholecystectomy in elderly patients. Materials and methods. We examined 84 patients aged 68.1 ± 0.6 years, with diagnosed gallstone disease, acute cholecystitis, who underwent laparoscopic cholecystectomy. Patients were randomized into 2 groups: Group I - inhalation anesthesia based on sevoflurane with mechanical ventilation; Group II - TBA based on propofol with mechanical ventilation. Hemodynamic parameters, dynamics of stress markers (cortisol, insulin, glucose) and cognitive function were investigated. Results. Glucose and insulin levels in both groups remained within normal limits at all stages of the study. The baseline cortisol level was higher than normal in both groups, but at 4, 5, 6 stages of the study decreased significantly compared with baseline values (p<0.001). In the study of cognitive functions by the Luria test and the MMSE scale, a significant decrease was found in both groups on the day after surgery. According to the Luria test, the score in group I significantly decreased the day after surgery against the period before premedication by 8.7% (p<0.001), in group II - by 10.1% (p<0.001); according to the MMSE scale, the score in group I significantly decreased on the day after surgery against the period before premedication by 6.0% (p<0.001), in group II - by 6.3% (p<0.001). On the fifth postoperative day, no significant differences in baseline values ​​between the Luria test and the MMSE scale were detected. Conclusions.  The comparative analysis of the dynamics of stress marker levels in both groups revealed some advantages of general sevoflurane-based anesthesia in antistress protection of patients in the perioperative period during laparoscopic cholecystectomy compared with total intravenous anesthesia based on propofol. However, the effectiveness of anti-stress protection of both types of anesthesia was sufficient. According to the correlation analysis, an inverse correlation was found between the state of cognitive functions in the postoperative period and the level of cortisol in the intraoperative period

scholarly journals THE IMPORTANCE OF NON-INVASIVE REGIONAL BRAIN OXIMETRY IN PREVENTING POSTOPERATIVE COGNITIVE DYSFUNCTION DURING LAPAROSCOPIC CHOLECYSTECTOMY IN ELDERLY AND SENILE PATIENTS

2020 ◽  
Vol 4 ◽  
pp. 11-17
Author(s):  
Olena Bielykh
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Cognitive Dysfunction ◽  
Cognitive Functions ◽  
Gallstone Disease ◽  
Postoperative Cognitive Dysfunction ◽  
Test Group ◽  
Non Invasive ◽  
Regional Brain ◽  
Group I ◽  
Group Ii

The adverse effect of general anesthesia in elderly patients during surgery requires monitoring of functions and processes to identify their dangerous abnormalities to prevent complications. The aim of the study. To establish the effectiveness of non-invasive regional brain oximetry with rSO2 determination during anesthetic support in laparoscopic cholecystectomy (LCE) to prevent postoperative cognitive dysfunction in elderly and senile patients. Material and methods. 84 elderly and senile patients with diagnosed gallstone disease, acute cholecystitis, who underwent LCE with sevofluran inhalational anesthesia and total intravenous anesthesia with propofol were examined. rSO2 was monitored. Cognitive functions were assessed using neuropsychological scales and the MMSE mental state examination scale. Results. rSO2 was found to be significantly decreased during the carbon dioxide insufflation as compared to before premedication: in LH (left hemisphere) – by 7.0 %, in RH (right hemisphere) – by 6.9 % (Group I); in LH – by 7.4 %, in RH – by 7.5 % (Group II). rSO2 was significantly increased during the surgery, particularly in the middle of the operation, as compared to before premedication: in LH – by 14.66 %, in RH – by 13.94 % (Group I); in LH – by 11.60 %, in RH – by 11.53 % (Group II). The day following the surgery, cognitive functions significantly decreased by 8.7 % on the Luria's test, by 6.0 % on the MMSE test (Group I); in Group II – by 10.1 % and 6.3 %, respectively, as compared to before premedication. On Day 5 after the surgery, cognitive functions decreased by 2.7 % on the Luria's test, by 0.35 % on the MMSE test (Group I); in Group II – by 2.7 % and 0.35 %, respectively, as compared to before premedication. Conclusions. A decrease in rSO2 can occur during LCE in the Trendelenburg position, despite the fact that other intraoperative indicators remain stable, which allows it to remain unrecognized. rSO2 monitoring in the perioperative period contributes to alertness and timely measures to prevent postoperative cognitive dysfunction.

scholarly journals Autoantibody as markers of the heart state in patients with vibration disease burdened diabetes mellitus

2020 ◽  
Vol 22 (2) ◽  
pp. 311-318
Author(s):  
L. B. Masnavieva ◽  
I. V. Kudaeva ◽  
Yu. A. Kuznetsova
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Thrombus Formation ◽  
The State ◽  
Myocardial Cells ◽  
Diabetes Group ◽  
Vibration Disease ◽  
Group I ◽  
Group Ii

Physical and chemical factors, obesity, lipid metabolism disorder, diabetes affect the state of the vascular endothelium, the processes of thrombus formation, fibrinolysis and increase the risk of developing cardiovascular diseases. It can be assumed that the development and course of pathological processes in the cardiovascular system, caused by vibration disease with the onset of diabetes, will undergo changes. The purpose of the study was to assess the state of heart condition according to the level of specific autoantibodies with the combined effect of vibration disease and type 2 diabetes mellitus. Patients with vibration disease (group I), patients with type 2 diabetes (group II) and persons with vibration disease in combination with type 2 diabetes (group III) were examined. Individuals do not have a history of coronary heart disease, stroke, and myocardial infarction have been included in obsledrovanie. Serum levels of specific autoantibodies characterizing the state of the heart have been studied. It was revealed that the content of autoantibodies to 1-adrenoreceptors in patients of group I was higher than in individuals of group II. The relative content of autoantibodies to the components of the membrane and cytoplasm of myocardial cells in patients of groups I-III did not differ. It was found that elevated levels of autoantibodies to components of the membrane and cytoplasm of myocardial cells, cardiomyosin, 1-adrenoreceptors were observed more often in patients with vibration disease combined with diabetes and in persons with vibration disease than in people with diabetes. Persons with a reduced content of autoantibodies to 1-adrenergic receptors were not detected among patients of groups I and III. Changes in the levels of specific autoantibodies in persons with vibration disease may indicate the development of functional metabolic and structural changes in the heart, disorders of its electrical activity that have not yet been manifested in the form of a pathological process. Lower levels of 1-adrenoceptor autoantibodies in patients with type 2 diabetes without vibration disease can be caused by increased levels of catecholamines, which is characteristic of diabetics. Further research, including clinical data and indicators of functional diagnostics is necessary to confirm our assumptions.

scholarly journals Levobupivacaine in spinal anesthesia for primary knee and hip arthroplasty

2020 ◽  
Vol 27 (1) ◽  
pp. 31-35
Author(s):  
K. Yu. Ukolov ◽  
V. L. Ayzenberg ◽  
M. V. Kapirina ◽  
M. E. Mikitina
Keyword(s):  
Elderly Patients ◽  
Spinal Anesthesia ◽  
Knee Arthroplasty ◽  
Hip Arthroplasty ◽  
Postoperative Nausea And Vomiting ◽  
Anaesthetic Agents ◽  
Group I ◽  
Primary Knee Arthroplasty ◽  
Group Ii ◽  
Knee And Hip Arthroplasty

Introduction. Spinal anesthesia is widely used in major orthopedic. Primary hip and knee arthroplasty are major surgical procedures associated with significant potential morbidity in elderly patients. This increases requirement to surgical and anesthetic procedures. Some studies provide evidence that levobupivacaine when used as an alternative to bupivacaine in spinal anesthesia is less cardiotoxic and neurotoxic. Aim: To compare the efficacy and safety of these two spinal anaesthetic agents in elderly patients undergoing primary hip or knee replacement. Patients and methods. The study included 90 patients performed arthroplasty with spinal anesthesia. I group patients received spinal anesthesia bupivacaine 0,5%, II group patients received intrathecal levobupicavaine 0.5%. Group I (n=60), 22 (37%) underwent primary hip arthroplasty, and 38 (63%) patients that underwent primary knee arthroplasty with mean age (65,4 + 6,5). Group II (n=30), 18 (60%) patients that underwent primary total hip arthroplasty and 12 (40%) patients that underwent primary knee arthroplasty with mean age (65,5 + 8,1). Anesthesia algorithm did not differ for both groups. Results. Vital parameters and adverse effects in relation to spinal anesthesia were observed. Decrease of heart rate was more significant in group II. Blood pressure parameters were comparable to both groups though, 10% of Group I patients received infusion of norepinephrine for treatment of hypotension. The two groups were comparable with glucose and lactate variations as well as the duration of analgesia and postoperative nausea and vomiting. No postoperative delirium was noted in both groups. Conclusion. Spinal anesthesia with levobupivacaine is more safe for elderly patients undergoing knee and hip arthroplasty.

scholarly journals Impact of Age on Short- and Long-Term Outcomes after Pancreatoduodenectomy for Periampullary Neoplasms

2020 ◽  
Vol 2020 ◽  
pp. 1-6 ◽  
Author(s):  
Mario Gruppo ◽  
Francesca Tolin ◽  
Boris Franzato ◽  
Pierluigi Pilati ◽  
Ylenia Camilla Spolverato ◽  
...  
Keyword(s):  
Overall Survival ◽  
Elderly Patients ◽  
Adjuvant Treatment ◽  
Long Term Outcomes ◽  
Group I ◽  
Periampullary Neoplasms ◽  
Short And Long Term ◽  
Group Ii ◽  
The Impact

Background. Although mortality and morbidity of pancreatoduodenectomy (PD) have improved significantly over the past years, the impact of age for patients undergoing PD is still debated. This study is aimed at analyzing short- and long-term outcomes of PD in elderly patients. Methods. 124 consecutive patients who have undergone PD for pancreas neoplasms in our center between 2012 and 2017 were analyzed. Patients were divided into two groups: group I (<75 years) and group II (≥75 years). Demographic features and intraoperative and clinical-pathological data were collected. Primary endpoints were perioperative morbidity and mortality; complications were classified according to the Clavien-Dindo Score. Secondary endpoints included feasibility of adjuvant treatment and overall survival rates. Results. A total of 106 patients were included in this study. There were 73 (68.9%) patients in group I and 33 (31.1%) in group II. Perioperative deceases were 4 (3.6%), and postoperative pancreatic fistulas were 34 (32.1%). Significant difference between two groups was demonstrated for the ASA Score (p=0.004), Karnofsky Score (p=0.025), preoperative jaundice (p=0.004), and pulmonary complications (p=0.034). No significance was shown for diabetes, radicality of resection, stage of disease, operative time, length of stay, postoperative complications according to the Clavien-Dindo Score, postoperative mortality, pancreatic fistula, and reoperation rates. 69.9% of the patients in group I underwent adjuvant treatment vs. 39.4% of the older ones (p=0.012). Mean overall survival was 28.5 months in group I vs. 22 months in group II (p=0.909). Conclusion. PD can be performed safely in elderly patients. Advanced age should not be an absolute contraindication for PD, even if greater frailty should be considered. The outcome of elderly patients who have undergone PD is similar to that of younger patients, even though adjuvant treatment administration is significantly lower, demonstrating that surgery remains the main therapeutic option.

scholarly journals Xylazine, diazepam and midazolam premedicated ketamine anaesthesia in White Leghorn cockerels for typhlectomy

2006 ◽  
Vol 77 (1) ◽  
Author(s):  
S.K. Maiti ◽  
R. Tiwary ◽  
P. Vasan ◽  
A. Dutta
Keyword(s):  
Muscle Relaxation ◽  
Recovery Period ◽  
White Leghorn ◽  
Group Iii ◽  
Blood Electrolytes ◽  
Group I ◽  
Baseline Values ◽  
Group Ii ◽  
Single Comb ◽  
Surgical Operations

Thee different combinations of ketamine hydrochloride were used to induce general anaesthesia for surgical operations (typhlectomy) in 30 adult, single-comb White Leghorn cockerels. They were randomly divided into three groups, each comprising 10 birds. Birds in Group I received xylazine-ketamine combinations at the dose rate of 2 mg xylazine and 10 mg ketamine per kg i.v., whereas birds of Group II received diazepam (2.5 mg / kg i.v.) and 5 min later ketamine (75 mg / kg i.m.). In the Group III, midazolam (2 mg / kg i.m.) and 5 min later ketamine (50 mg / kg i.v.) was administered. The onset of sedation / anaesthesia was shortest (1.60 + 0.27 min) in Group I, followed by Group II (8.40 + 0.83 min) and Group III (17.10 + 1.71 min). Recovery period was shortest in the Group I (65-75 min) followed by Group II (80-85 min) and Group III (92-105 min). Sedation, muscle relaxation and surgical anaesthesia was optimal and excellent in Group I compared with the other two groups. Torticollis, salivation and dyspnoea were observed in Group III. Short-term limb contractions were present in all birds in Groups II and III, up to 20 min of observation. Recovery from anaesthesia was smooth in all three groups. A Surgical procedure (typhlectomy) was performed on all birds. Hypothermia was observed in Group II, whereas heart and respiratory depression was recorded in Group I. Blood sugar level did not vary significantly in any anaesthetic regime. The reduction of haemoglobin was maximum in Group II compared with Groups I and III. Hypoxaemia and hypercapnaea were elevated in all birds in Groups II and III. Blood electrolytes did not vary significantly from the baseline values among the three groups of birds during the period of observation (120 min). The xylazine-ketamine combination was found to be the best anaesthesia for surgical intervention in chickens.

scholarly journals THE STATE OF CHILDREN MASTICATORY MUSCLES WITH DENTITION DEFECTS IN THE FRONTAL AREA AND NARROWING OF DENTAL ARCHES IN THE TRANSVERSE PLANE

10.23856/4336 ◽  
2021 ◽  
Vol 43 (6) ◽  
pp. 279-286
Author(s):  
Svitlana Savonik
Keyword(s):  
Orthodontic Treatment ◽  
Masticatory Muscles ◽  
The State ◽  
Frontal Area ◽  
Orthodontic Appliance ◽  
Dynamic Changes ◽  
Group I ◽  
Group Ii ◽  
Removable Appliances ◽  
Better Than

Orthopedic and orthodontic treatment of 49 patients aged 6 to 17 years with dentition defects in the frontal area was examined and performed to conduct and determine the state of the masticatory muscles in children with dentition defects. Patients were divided into two groups depending on the period of formation of the dento-maxillaire system and each of the groups was divided into two subgroups depending on the method of treatment and the mechanism of fixation of the orthodontic appliance in the oral cavity. When comparing the indicators between groups I A and I B, we can state that there were more qualitative and dynamic changes in electromyographic indicators in children of group I B than group I A. When comparing the data received after orthopedic and orthodontic treatment of children in group II, we can state that quantitative and qualitative indicators of electromyography for group II B were better than those of children in group II A. In children who were treated with removable appliances, these indicators improved, but remained at a worse level than in those treated with non-removable appliances.

scholarly journals Use of Noninvasive Cerclage in Combination of Micronized Progesterone in Miscarriage Of Multifetal Pregnancy

2017 ◽  
Vol 24 (4) ◽  
Author(s):  
Iryna Nikitina ◽  
Alla Boychuk ◽  
Valentina Kondratiuk ◽  
Tatyana Babar
Keyword(s):  
High Risk ◽  
Pregnant Women ◽  
The State ◽  
Control Group ◽  
Group I ◽  
Prophylactic Measures ◽  
Neonatal Adaptation ◽  
Group Ii ◽  
Multifetal Pregnancy ◽  
Micronized Progesterone

We represent the results of the combined method of treatment and prevention of miscarriage in women with a multiple pregnancy and a high risk of the threat of termination the pregnancy because of using the obstetric unloading pessaries, combined with micronized progesterone. The efficiency of this method of treatment is evidenced by the rapid elimination of clinical symptoms of threatened abortion, accelerating the regression of ultrasound markers, reducing the number of complications in of pregnant women and reducing the time of their stay in hospital.Goal: To evaluate the effectiveness of the handling the obstetric pessary in combination with micronized progesterone at women with multifetal pregnancy and a high risk of miscarriage.Materials and methods. We analyzed 120 cases of multifetal pregnancies with signs of miscarriage within the terms from 16 to 28 weeks. The first group of the examined women was: 40 pregnant women with twins and signs of miscarriage, who in the scheme of treatment and prophylactic measures were offered to use the unloading obstetric pessaries in combination with continuous therapy by natural micronized progesterone until 36 weeks of pregnancy. The second group included 40 pregnant women with twins, who were laid seam on the cervix because of istmicocervical insufficiency and were applied short-term courses of therapy by gestagens. The control group comprised 40 pregnant women with twins at the age of 16-28 weeks of pregnancy who were conducted the therapy about the threat of miscarriage according to the current clinical protocols (Order of the Ministry of Health of Ukraine No. 624). It was carried out the analysis of the course of pregnancy, childbirth, the postpartum period and the state of neonatal adaptation in the surveyed groups.Results of the research and their discussion. In the first group, urgent childbirth occurred in 34 (85%) cases, in group II in 29 (72.5%) cases, in control group – in 25 (62.5%) cases. Cesarean delivery was performed in 7 (17.5%) patients of group I pregnant women, in 9 (22.5%) of group II patients and in 11 (27.5%) in the pregnant group. When studying the state of neonatal adaptation of newborns in the examined groups, the following results were obtained. The average weight of the newborns in group I was 3245 ±280 g, in group II 2865 ±365 g, in the control group - 2975 ±325 g (p>0.05). The evaluation of the state of newborns on the Apgar scale, respectively at the 1st and 5th minutes, was respectively: in newborns of the I group, 7.5 ± 1.4 and 8.4 ± 1.3 points, in group II - 7.3 ± 1.6 and 8.2 ± 1.1 points, in the control group – 7.2 ± 1.6 and 8.6 ± 1.2 (р 1-р 2> 0.05).Conclusions. Comprehensive prophylaxis of non-pregnancy in multiple pregnancies, combining the use of a traumatic cardiac cervix with the help of unloading obstetric pussies with progesterone preparations, allows prolonging pregnancy, preventing the development of prematurity, contributes to the improvement of perinatal indicators.

scholarly journals 10D: Feasibility Study of a Novel Low-cost Brazilian Emergency Mechanical Ventilator

2020 ◽  
Author(s):  
Uri Adrian Prync Flato ◽  
Patricia C. dos Santos ◽  
Fábio Manhoso ◽  
Fernanda Mesquita Serva ◽  
Jeferson Dias ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Low Cost ◽  
Pulmonary Ventilation ◽  
Animal Experiments ◽  
Mechanical Ventilator ◽  
Mechanical Ventilators ◽  
Group I ◽  
Emergency Transport ◽  
The Mean ◽  
Group Ii

Abstract Background: The current need for pulmonary mechanical ventilation related to COVID-19 exceeds the ability of health systems worldwide to acquire and produce mechanical ventilators. The major cause of mortality in patients with this disease is hypoxemia secondary to an inflammatory storm in the lungs associated with thrombotic events. A partnership was established between the university and the private engineering and industrial automation sector to concept and design novel a low-cost emergency mechanical ventilator that could be rapidly available for use in emergency, transport or low-resource health care system, and attend the urgent demand of artificial respiratory system that is need worldwide. It was evaluated the viability of oxygenation and pulmonary ventilation with an emergency mechanical ventilation device called 10D-EMV in animal experiments. A two-stage sequential adaptive study was conducted in 10 sheep, divided into group I (PEEP valve close to the device) and group II (PEEP valve distal to the device). Each animal underwent mechanical ventilation for a total of 120 minutes. Results: The mean oxygenation in group I and group II were 368 mmHg and 366 mmHg, respectively, while the mean partial pressure of carbon dioxide was 58 mmHg and 48 mmHg. Conclusion: This study demonstrates the viability of the 10D device as a novel proposed emergency mechanical ventilator, in order to attend the pandemics demand. Further clinical studies in humans are needed to assess its safety and efficacy.

scholarly journals Unsuccessful weaning from mechanical ventilation in children and ways to avoid it

2020 ◽  
pp. 82-89
Author(s):  
O. V. Filyk
Keyword(s):  
Mechanical Ventilation ◽  
Protective Ventilation ◽  
Lung Protective Ventilation ◽  
Weaning From Mechanical Ventilation ◽  
Ventilation Strategy ◽  
Group I ◽  
Protective Ventilation Strategy ◽  
Elective Tracheostomy ◽  
Group Ii ◽  
Lung Protective Ventilation Strategy

The aim of the work: to determine causes of unsuccessful weaning depending on subglottic edema markers, level of sedation and sedation-agitation, changes in neurological status and bulbar disorders in children with different types of respiratory failure. Materials and Methods. We conducted a prospective cohort single-center study at the Department of Anesthesiology and Intensive Care at Lviv Regional Children's Clinical Hospital "OHMATDYT". We included 89 patients aged 1 month – 18 years with acute respiratory failure who was mechanically ventilated for more than 3 days. They were randomly divided into 2 groups. Group I included patients who received lung-protective ventilation strategy and assessment central nervous system function and the percentage of leakage of the gas mixture near the endotracheal tube; group II – patients who received diaphragm-protective in addition to lung-protective ventilation strategy and took into account the results of central nervous system assessment and respiratory gas mixture leakage near endotracheal tube during weaning from mechanical ventilation. The primary endpoint was the frequency of reintubations, the secon­dary endpoint was the frequency of complications (tracheostomy). 82 patients were included in the data analysis. Patients were divided into age subgroups: subgroup 1 – children 1 month – 1 year; subgroup – children 1–3 years; subgroup 3 – children 3–6 years; subgroup 4 – children 6–13 years; subgroup 5 – children 13–18 years. Results and Discussion. The frequency of reintubations in patients of the age subgroup 1 was reduced in group II to 5.3 % compared with 22.7 % in group I (p = 0.02), which was accompanied by a higher frequency of elective tracheostomy (before the first attempt of weaning from mechanical ventilation) which was 11 % in comparison with 0 %, p = 0.001). The frequency of reintubations in the age subgroup 2 was reduced to 5.9 % in group II vs 20 % in group I (p = 0.04), and elective tracheostomy was performed in 18 % patients in group II vs 5 % patients in group I (p = 0.05). There were no significant differences in the frequency of reintubations among patients in the age subgroup 3 (14.2 % in group I vs 11.1 % in group II, p = 0.31); in the age subgroup 4 (13 % vs 17 %, p = 0.19); the age subgroup 5 (6 % vs 7 %, p = 0.72).

scholarly journals The effect of low dose midazolam in addition to ondansetron on post-operative nausea and vomiting in laparoscopic cholecystectomy – a comparative study

2014 ◽  
Vol 24 (1) ◽  
pp. 8-12
Author(s):  
MM Masum-Ul Haque ◽  
Montosh K Mondal ◽  
S Afroz ◽  
SS Akhter ◽  
Abdul Hye ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Nausea ◽  
Low Dose ◽  
Postoperative Nausea And Vomiting ◽  
Group Iv ◽  
Nausea And Vomiting ◽  
Group Iii ◽  
Group I ◽  
Group Ii ◽  
Post Operative Nausea

Background Nausea, retching and vomiting are among the most common postoperative complaints. Premedication with low dose midazolam in addition to ondansetron is more effective in controlling postoperative nausea and vomiting. Objectives This study was designed to observe the effect of low dose midazolam 7.5mg in addition to ondansetron 4mg on postoperative nausea and vomiting in laparoscopic cholecystectomy. Methods 100 patients of ASA grade I and II, age range 30-50 years and weight 50-70 kg were randomly selected by a blind envelop method. They were equally divided into four groups of 25 patients in group each. Group I received vitamin, Group II ondansetron 8mg, Group III ondansetron 8mg and midazolam 7.5mg and Group IV ondansetron 4mg and midazolam 7.5 mg orally one hour before operation. In the recovery room occurrence of nausea and vomiting was assessed for 24 hours. Results The incidence of nausea was in vitamin Group I 64%, in ond8 group II 32%, in ond8+mid7.5 group III 24% and in ond4+mid7.5 group IV 24%. The incidence among the groups was highly significant (p=0.008). The incidence of vomiting was in vitamin Group I 16%, in ond8 group II 16%, in ond8+mid7.5 group III 8% and in ond4+mid7.5 group IV 8%. The difference among the groups were not significant (p=0.808). Conclusion Low dose midazolam 7.5mg in addition to ondansetron 4mg is more effective in controlling postoperative nausea and vomiting in laparoscopic cholecystectomy. DOI: http://dx.doi.org/10.3329/jbsa.v24i1.19793 Journal of Bangladesh Society of Anaesthesiologists 2011; 24(1): 8-12

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