Effect of intravenous lidocaine combined with dexmedetomidine on postoperative nausea and vomiting after laparoscopic total hysterectomy

2019 ◽  
Author(s):  
Si-Qi Xu ◽  
Xia Ju ◽  
Sheng-Bin Wang ◽  
Sheng-Hong Hu ◽  
Qing Li ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Postoperative Nausea ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Controlled Study ◽  
Control Group ◽  
Total Hysterectomy ◽  
Pacu Stay ◽  
Dexmedetomidine Infusion ◽  
Laparoscopic Total Hysterectomy

Abstract Background A few studies have manifested that intravenous (IV) lidocaine or dexmedetomidine decreased the incidence of postoperative nausea and vomiting (PONV). We investigated whether lidocaine plus dexmedetomidine infusion could better reduce the incidence of PONV than placebo after laparoscopic total hysterectomy. Methods This prospective, randomized controlled study enrolled 126 women undergoing elective laparoscopic total hysterectomy with general anesthesia. They divided into the following two groups: patients in the lidocaine combined with dexmedetomidine group (group LD) received lidocaine (1.5 mg/kg loading, 1.5 mg/kg/h infusion) and dexmedetomidine (0.5 μg/kg loading, 0.4 μg/kg/h infusion), respectively. Patients in the control group (group CON) received the equal volume of saline. The primary outcome was the incidence of nausea, vomiting and PONV for the first 48 hours after surgery. The secondary outcomes included intraoperative propofol and remifentanil consumption, postoperative fentanyl requirement, Ramsay sedation score, and the incidence of bradycardia during post-anesthesia care unit (PACU) stay period. Results Data of 59 in CON and 60 in LD groups were analyzed. The incidence of nausea, vomiting, and PONV in group LD during the 0 to 2 hours and 24 to 48 hours after the operation was slightly lower than group CON, but the difference was not statistically significant between the two groups. The incidence of nausea, vomiting, and PONV was much lower in group LD than group CON at 2 to 24 hours after surgery (P<0.05, P<0.01, P<0.01, respectively). The cumulative requirement of fentanyl during the first 48 hours after surgery was significantly reduced in group LD compared to group CON (P<0.01, P<0.01, P<0.05, respectively). Propofol and remifentanil total dose in the intraoperative period was significantly lower in group LD compared with group CON (P<0.01 and P<0.01). However, the level of sedation and incidence of bradycardia during the PACU stay period were markedly increased in group LD compared with group CON (P<0.01 and P<0.01). Conclusion Lidocaine plus dexmedetomidine infusion markedly decreased the occurrence of nausea, vomiting and PONV within the 2 to 24 hours after laparoscopic total hysterectomy with general anesthesia. However, it increased the incidence of bradycardia and the level of sedation during the PACU stay period.

scholarly journals Comparison of Anesthesia Depth Monitoring using Conventional and Bispectral Index on Incidence and Severity of Nausea and Vomiting after Urological Surgeries

2018 ◽  
Vol 6 (2) ◽  
pp. 25
Author(s):  
Reihan Shenasi ◽  
Hamzeh Hoseinzadeh ◽  
Hasan Mohammadpor-Anvari ◽  
Davod Aghamohammadi ◽  
Reza Sari-Motlagh
Keyword(s):  
General Anesthesia ◽  
Bispectral Index ◽  
Postoperative Nausea ◽  
Operating Time ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Control Group ◽  
Anesthetic Drugs ◽  
Urological Surgery ◽  
Anesthesia Depth

Bispectral index parameter is used to guide the titration of general anesthesia. This monitoring improves recovery times and hospital discharges, as well as minimizes adverse events. The objective of this study is the comparison of anesthesia depth monitoring by conventional and bispectral index on nausea and vomiting after urological surgery. 180 participants who were scheduled for abdominal urological surgery were studied. Patients before induction of anesthesia were randomize into two groups with and without bispectral index monitoring. Incidence and severity of nausea and vomiting were recorded every 30 minutes for 2 hours and every 6 hours to 24 hours after surgery. The incidence of postoperative nausea and vomiting in Bispectral index group is 14.4% and 8.9% and in control group 28.9% and 23.3%, respectively. The risk of nausea and vomiting after surgery was reduced by 14.5% and 14.4%, respectively in patients monitored with bispectral index.INTRODUCTIONNausea is the conscious perception of medulla stimulation that is associated with vomiting center and create vomiting response (1). General anesthesia with the use of inhalants can cause nausea and vomiting after surgery (Postoperative nausea and vomiting, PONV). The incidence of PONV is reported about 20-30 percent (2). It seems that multiple-factor can cause PONV and few items such as anesthetic drugs, kind of surgery and personal risk factors is effective on PONV. These factors make into two categories that includes factors out of control by anesthesiologists and factors can control by anesthesiologists.1. Factors out of control by anesthesiologists: some of these factors are age, gender, past history of PONV and motion sickness, smoking, kind of surgery, operating time and anesthesia time, anxiety of patients and parents. 2. Factors controlled by anesthesiologists: these factors are associated of anesthesia settings, including premedications, kind of anesthesia, anesthesia drugs during surPublishedby Australian

scholarly journals Multimodal Low-opioid Anesthesia as an Effective Way to Prevent Postoperative Nausea and Vomiting. Pathophysiological Aspects of this Complication

2021 ◽  
Vol 6 (1) ◽  
pp. 101-106
Author(s):  
Т. Ovsiienko ◽  
◽  
M. Bondar ◽  
O. Loskutov ◽  
◽  
...  
Keyword(s):  
General Anesthesia ◽  
Postoperative Nausea ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Control Group ◽  
Average Dose ◽  
Kidney Surgery ◽  
Group 2 ◽  
Total Average ◽  
Group 1

Postoperative nausea and vomiting are common adverse effects of anaesthesia and surgery. Up to 80% of patients may be affected. These outcomes are a major cause of patient dissatisfaction. In addition, postoperative nausea and vomiting can independently cause the occurrence of rather serious complications of the postoperative period, such as aspiration of gastric contents into the airways, hemodynamic disorders in patients with a compromised cardiovascular system, failure of surgical sutures, bleeding, dehydration and electrolyte imbalance which ultimately can lead to disability of patients, prolongation of their hospitalization and higher treatment costs. Material and methods. The paper presents the results of our own research on the use of multimodal low-opioid general anesthesia as one of the methods for the prevention of postoperative nausea and vomiting during anesthetic provision of laparoscopic kidney surgery. The study involved 38 patients who underwent laparoscopic kidney surgery. Results and discussion. To compare the incidence of postoperative nausea and vomiting, patients were randomly divided into two groups. Group 1 used multimodal general anesthesia with standard opioid doses, while group 2 used multimodal low-opioid general anesthesia. The total average dose of fentanyl that was used during the entire time of anesthesia in the control group was 373.3 ± 50.8 μg (4.34 μg / kg / h). The total average dose of fentanyl that was used during the entire time of anesthesia in the study group was 217.39 ± 49.1 μg (1.76 μg / kg / h). In group 1, vomiting occurred in 4 patients out of 15 in the postoperative period, in group 2 there were 4 patients with vomitting, but out of 23 operated patients. The standardized rate of postoperative nausea and vomiting in the control group was 26.6%, in the main group it was 17.3%. Conclusion. As a result of comparing the incidence of postoperative nausea and vomiting in patients of both study groups, we found that a decrease in the dose of perioperative use of opioids helps to reduce the incidence of this complication, which increased the safety of anesthetic management, greatly facilitated and accelerated the rehabilitation of patients after laparoscopic kidney surgery. The work also highlighted and systematized information on the morphology of structures involved in the formation of postoperative nausea and vomiting, on the physiology of this process

Inspired Oxygen Fraction of 0.8 Does Not Attenuate Postoperative Nausea and Vomiting after Strabismus Surgery

2005 ◽  
Vol 103 (1) ◽  
pp. 6-10 ◽  
Author(s):  
Tanja A. Treschan ◽  
Christian Zimmer ◽  
Christoph Nass ◽  
Bernd Stegen ◽  
Joachim Esser ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Intravenous Administration ◽  
Postoperative Nausea ◽  
Postoperative Nausea And Vomiting ◽  
Strabismus Surgery ◽  
Nausea And Vomiting ◽  
Controlled Study ◽  
Oxygen Fraction ◽  
Significant Difference ◽  
Inspired Oxygen

Background Postoperative nausea and vomiting (PONV) is a distressing problem after strabismus surgery. An inspired oxygen fraction has been reported to decrease PONV in patients after colon resection and to be more effective than ondansetron after gynecologic laparoscopy. Therefore, in a randomized, prospective, placebo-controlled study, the authors tested whether an inspired oxygen fraction of 0.8 decreases PONV in patients undergoing strabismus surgery and whether oxygen is more effective than ondansetron. Methods With approval of the authors' institutional review board, 210 patients were randomly assigned to receive one of three treatments: (1) 30% inspired oxygen in air plus intravenous administration of saline, (2) 80% inspired oxygen in air plus intravenous administration of saline, or (3) 30% inspired oxygen in air plus 75 microg/kg ondansetron intravenously during induction. General anesthesia was standardized and included etomidate, alfentanil, and mivacurium for induction and sevoflurane for maintenance. PONV was evaluated 6 and 24 h postoperatively by an investigator unaware of treatment assignment. Results Overall postoperative incidence of nausea and vomiting was 41% for inspired oxygen fraction of 0.3 plus placebo, 38% for inspired oxygen fraction of 0.8 plus placebo, and 28% for inspired oxygen fraction of 0.3 plus ondansetron, respectively (P = 0.279). Therefore, there was no statistically significant difference of PONV incidence among groups. Conclusions An inspired oxygen fraction of 0.8 during general anesthesia with sevoflurane does not decrease PONV in patients undergoing strabismus repair. Ondansetron also did not significantly decrease PONV in our study setting.

scholarly journals Aggressive Prophylactic Treatments for Postoperative Nausea and Vomiting Improve Outcomes in Pediatric Adenotonsillectomy Procedure

2020 ◽  
Vol 25 (4) ◽  
pp. 303-308
Author(s):  
Tatyana Demidovich ◽  
Orlando Perez-Franco ◽  
Marco Silvestrini-Suarez ◽  
Pin Yue
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
General Anesthesia ◽  
Postoperative Nausea ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Antiemetic Drugs ◽  
Pacu Stay

OBJECTIVE Postoperative nausea and vomiting (PONV) is an extremely common side effect of general anesthesia that is difficult to manage. We tested a hypothesis that an aggressive prophylactic intervention with additional antiemetic drugs will reduce the incidence of PONV in a high-risk pediatric population undergoing adenotonsillectomy. METHODS In this retrospective study, pediatric patients undergoing adenotonsillectomy were screened for their risk factors for PONV. Patients who had 3 or more risk factors were identified as high risk and received either scopolamine patch preoperatively (for patients over 40 kg body weight) or diphenhydramine immediately postextubation in addition to ondansetron and dexamethasone, which are given routinely. Incidences of PONV within the first 60 minutes of a postanesthesia care unit (PACU) stay were collected and analyzed. RESULTS Overall postoperative vomiting rates during the first hour of a PACU stay were 4.3% for the group that was treated with dexamethasone and ondansetron only and 3.9% for the group that was treated with additional antiemetic drugs. Aggressive prophylactic management of PONV did reduce the rate of nausea and vomiting in a group of high-risk patients (p &lt; 0.0001). The postoperative antiemetic drug usage was also decreased during the first 60 minutes of a PACU stay. However, the approach did not reduce the overall rate of PONV for the entire study population (p = 0.1612 for nausea and p = 0.0678 for vomiting). CONCLUSION Aggressive intraoperative management of PONV with additional antiemetic drugs are beneficial in high-risk pediatric population. Intraoperative diphenhydramine usage decreased the rate of PONV. However, preoperative scopolamine patch prevention did not improve PONV, which may be related to the drug's longer onset of action. Our result suggests that current clinical practice is undertreating PONV in pediatric patients receiving general anesthesia.

scholarly journals Is Infusion of Subhypnotic Propofol as Effective as Dexamethasone in Prevention of Postoperative Nausea and Vomiting Related to Laparoscopic Cholecystectomy? A Randomized Controlled Trial

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Mine Celik ◽  
Aysenur Dostbil ◽  
Mehmet Aksoy ◽  
Ilker Ince ◽  
Ali Ahiskalioglu ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Nausea ◽  
Controlled Trial ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Controlled Study ◽  
Control Group ◽  
Double Blind ◽  
Significant Difference ◽  
Group D

Background. Postoperative nausea and vomiting (PONV) is one of common complications in patients undergoing laparoscopic cholecystectomy (LC). Aim of this study was to compare the efficacy of subhypnotic (1 mg/kg/h) infusion of propofol with dexamethasone on PONV in patients undergoing LC.Methods. A total of 120 patients were included in this randomized, double-blind, placebo-controlled study. Patients were randomly assigned to 3 groups; patients of group dexamethasone (group D) were administrated 8 mg dexamethasone before induction of anesthesia, patients of group propofol (group P) were infused to subhypnotic (1 mg/kg/h) propofol during operation and patients of group control (group C) were applied infusion of 10% intralipid. The incidence of PONV and needs for rescue analgesic and antiemetic were recorded in the first 24 h postoperatively.Results. In the 0–24 h, the incidence of PONV was significantly lower in the group D and group P compared with the group C (37.5%, 40%, and 72.5%, resp.). There was no significant difference in the incidence of PONV and use of antiemetics and analgesic between group D and group P.Conclusion. We concluded that infusion of propofol 1 mg/kg/h is as effective as dexamethasone for the prevention of PONV during the first 24 hours after anesthesia in patients undergoing LC.

scholarly journals Effects of Intraoperative Dexamethasone and Ondansetron on Postoperative Nausea and Vomiting in Microvascular Decompression Surgery: A Randomized Controlled Study

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Cattleya Thongrong ◽  
Patitha Chullabodhi ◽  
Pornthep Kasemsiri ◽  
Amnat Kitkhuandee ◽  
Narin Plailaharn ◽  
...  
Keyword(s):  
Normal Saline ◽  
Microvascular Decompression ◽  
Postoperative Nausea ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Controlled Study ◽  
Control Group ◽  
Decompression Surgery ◽  
Microvascular Decompression Surgery ◽  
Double Blinded

Background. Postoperative nausea and vomiting (PONV) is a common problem and may lead to catastrophic complications, especially in neurosurgical cases. The aim of this study was to evaluate the effects of dexamethasone and ondansetron for preventing PONV in patients who underwent microvascular decompression (MVD) surgery. Methods. A prospective, double-blinded, randomized control trial was conducted with 54 patients who underwent MVD. Patients were allocated into two groups. The study group (Gr. D) received intraoperative dexamethasone 4 mg iv and ondansetron 4 mg iv, whereas the control group (Gr. N) received placebo (0.9% normal saline 1 ml iv and 0.9% normal saline 2 ml iv). The incidence and severity of PONV were observed at 1, 2, 4, and 24 hr postsurgery. Results. At 1, 2, 4, and 24 hr postsurgery, Gr. D had a lower incidence (7.4%, 11.1%, 29.6%, and 66.7%) and lower severity of PONV than Gr. N (18.5%, 29.6%, 37.0%, and 81.5% at 1, 2, 4, and 24 hr; p>0.05). The requirement for antiemetic drugs was not significantly different between the groups (p>0.05). Conclusion. Administration of dexamethasone and ondansetron 4 mg seemed to decrease the incidence of PONV in the first 24 hours but not significantly. Therefore, further studies are to be carried out by escalating either dexamethasone dose or the dose of ondansetron or both.

scholarly journals Effects of lidocaine, dexmedetomidine, and their combination infusion on postoperative nausea and vomiting following laparoscopic hysterectomy: a randomized controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Siqi Xu ◽  
Shengbin Wang ◽  
Shenghong Hu ◽  
Xia Ju ◽  
Qing Li ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Continuous Infusion ◽  
Postoperative Nausea ◽  
Postoperative Nausea And Vomiting ◽  
Laparoscopic Hysterectomy ◽  
Nausea And Vomiting ◽  
Bolus Infusion ◽  
Significant Difference ◽  
Vas Scores ◽  
Pacu Stay

Abstract Background A few studies have reported that administration of lidocaine and dexmedetomidine relieves the incidence of postoperative nausea and vomiting (PONV). We explored whether combined infusion of lidocaine plus dexmedetomidine had lower occurrence of PONV undergoing laparoscopic hysterectomy with general anesthesia. Methods A total of 248 women undergoing elective laparoscopic hysterectomy were allocated into the following four groups: the control group (group C, n = 62) received an equal volume of saline, the lidocaine group (group L, n = 62) received intravenous lidocaine (bolus infusion of 1.5 mg/kg over 10 min, 1.5 mg/kg/h continuous infusion), the dexmedetomidine group (group D, n = 62) received dexmedetomidine administration (bolus infusion of 0.5 µg/kg over 10 min, 0.4 µg/kg/h continuous infusion), and the lidocaine plus dexmedetomidine group (group LD, n = 62) received combination of lidocaine (bolus infusion of 1.5 mg/kg over 10 min, 1.5 mg/kg/h continuous infusion) and dexmedetomidine administration (bolus infusion of 0.5 µg/kg over 10 min, 0.4 µg/kg/h continuous infusion). The primary outcome was the incidence of nausea, vomiting, and PONV during the first 48 h after surgery. The secondary outcomes included the incidence of total 24 h PONV after surgery, intraoperative remifentanil requirement, postoperative pain visual analogue scale (VAS) scores and fentanyl consumption, the incidence of bradycardia, agitation, shivering, and mouth dry during post-anesthesia care unit (PACU) stay period. Results The occurrence of nausea and PONV in group LD (5.0 and 8.3%) at 0–2 h after operation was lower than group C (21.7 and 28.3%) (P < 0.05). There was no statistically significant difference with respect to occurrence of nausea and PONV in groups L (13.3 and 20.0%) and D (8.3 and 13.3%) at 0–2 h after operation compared to group C (21.7 and 28.3%). The incidence of nausea, vomiting, and PONV at 2–24 and 24–48 h after surgery in all four groups was not statistically significant. The incidence of total 24 h PONV in group LD (33.3%) was significantly decreased compared to group C (60.0%) (P < 0.05). The cumulative consumption of fentanyl at 6 and 12 h after surgery was significantly reduced in group LD compared to other three groups (P < 0.05). The pain VAS scores were significantly decreased at 2, 6, and 12 h after operation in group LD compared to other three groups (P < 0.05). Remifentanil dose in the intraoperative period was significantly lower in groups LD and D compared with groups C and L (P < 0.05). The number of mouth dry, bradycardia, and over sedation during the PACU stay period was markedly increased in group LD (28.3, 30.0, and 35.0%, respectively) compared with groups C (1.7, 1.7, and 3.3%, respectively) and L (3.3, 5.0, and 6.7%, respectively) (P < 0.05). Conclusions Lidocaine combined with dexmedetomidine infusion markedly decreased the occurrence of nausea and PONV at 0–2 h as well as the total 24 h PONV. However, it significantly increased the incidence of mouth dry, bradycardia, and over sedation during the PACU stay period after laparoscopic hysterectomy with general anesthesia. Trial registration ClinicalTrials.gov (NCT03809923), registered on January 18, 2019.

Maximal Pharmacologic Reduction of Postoperative Nausea and Vomiting in Patients Undergoing Aesthetic Breast Surgery Under General Anesthesia

2016 ◽  
Vol 33 (4) ◽  
pp. 189-192 ◽  
Author(s):  
Mauree NaShea Beard ◽  
Arup De
Keyword(s):  
General Anesthesia ◽  
Postoperative Nausea ◽  
Breast Surgery ◽  
Postoperative Nausea And Vomiting ◽  
Multimodal Analgesia ◽  
Nausea And Vomiting ◽  
Surgical Patients ◽  
Control Group ◽  
Limited Data ◽  
Aesthetic Breast

Postoperative nausea and vomiting (PONV) is a major patient dissatisfier in aesthetic ambulatory surgical patients. Limited data exist demonstrating single surgeon reduction in PONV after utilizing modern pharmacologic techniques for analgesia and PONV chemoprophylaxis for patients who receive general anesthesia. In our study, multimodal analgesia included pregabalin, oxycontin, ketamine, and opioids; PONV chemoprophylaxis included transdermal scopolamine, diphenhydramine, dexamethasone, and ondansetron. A treatment arm of 36 patients undergoing aesthetic breast surgery was evaluated prospectively and compared with a retrospective control group of 47 patients who underwent similar procedures in the prior year. The aggressive screening for PONV risk factors preoperatively and preemptive treatment resulted in an overall reduction in PONV rate from 31.9% to 5.6%.

Amisulpride Prevents Postoperative Nausea and Vomiting in Patients at High Risk

2018 ◽  
Vol 128 (6) ◽  
pp. 1099-1106 ◽  
Author(s):  
Peter Kranke ◽  
Sergio D. Bergese ◽  
Harold S. Minkowitz ◽  
Timothy I. Melson ◽  
David G. Leiman ◽  
...  
Keyword(s):  
High Risk ◽  
General Anesthesia ◽  
Postoperative Nausea ◽  
Rescue Medication ◽  
Elective Surgery ◽  
Medication Use ◽  
Postoperative Nausea And Vomiting ◽  
Complete Response ◽  
Nausea And Vomiting ◽  
Control Group

Abstract Background Postoperative nausea and vomiting causes distress for patients and can prolong care requirements. Consensus guidelines recommend use of multiple antiemetics from different mechanistic classes as prophylaxis in patients at high risk of postoperative nausea and vomiting. The prophylactic efficacy of the dopamine D2/D3 antagonist amisulpride in combination with other antiemetics was investigated. Methods This double-blind, randomized, placebo-controlled, international, multicenter trial was conducted in 1,147 adult surgical patients having three or four postoperative nausea and vomiting risk factors. Patients were randomized to receive either intravenous amisulpride (5 mg) or matching placebo at induction of general anesthesia, in addition to one standard, nondopaminergic antiemetic, most commonly ondansetron or dexamethasone. Vomiting/retching, nausea, and use of rescue medication were recorded for 24 h after wound closure. The primary endpoint was complete response, defined as no emesis or rescue medication use in the 24-h postoperative period. Results Complete response occurred in 330 of 572 (57.7%) of the amisulpride group and 268 of 575 (46.6%) of the control group (difference 11.1 percentage points; 95% CI, 5.3 to 16.8; P &lt; 0.001). The incidences of emesis (13.8% vs. 20.0%, P = 0.003), any nausea (50.0% vs. 58.3%, P = 0.002), significant nausea (37.1% vs. 47.7%, P &lt; 0.001), and rescue medication use (40.9% vs. 49.4%, P = 0.002) were significantly lower in the amisulpride group. Adverse events and laboratory and electrocardiogram abnormalities occurred no more frequently with amisulpride than with placebo. Conclusions Intravenous amisulpride was safe and effective as prophylaxis of postoperative nausea and vomiting when given in combination with an antiemetic from another class to adult patients at high risk for suffering postoperative nausea and vomiting undergoing elective surgery under inhalational general anesthesia.

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