Comparison of aprepitant and dexamethasone versus metoclorpramide and dexamethasone for prevention of post-operative nausea and vomiting in patients undergoing laparoscopic cholecystectomy.

Objective: To compare the efficacy of aprepitant and dexamethasone versus metoclopramide and dexamethasone combination in prevention of post-operative nausea and vomiting in females undergoing laparoscopic cholecystectomy. Study Design: Prospective Comparative study. Setting: Department of Anesthesia, CMH Lahore. Period: October 2019 to April 2020. Material & Methods: A total of 140 female patients planned for laparoscopic cholecystectomy under general anesthesia, of age ranges from 35-65 years and ASA classification I and II were recruited for the study and were divided into two equal groups. In group A (n=70), patients were given oral aprepitant 80 mg with once sip of water one hour prior to induction and dexamethasone 8 mg upon induction. In group M (n=70), patients were given a placebo one hour prior to induction and intravenous metoclopramide 10 mg and dexamethasone 8 mg upon induction. Results: Age range in this study was from 37 to 65 years with mean age of 46.82 ± 7.29 years. The mean age of patients in group A was 45.73 ± 6.77 years and in group M was 47.91 ± 7.66 years with p-value of 0.076. In our study, significant difference was found between the efficacy of two groups of drugs. The efficacy of aprepitant and dexamethasone was found in 62 (88.57%) patients, while with metoclopramide and dexamethasone, it was found in 51 (72.86%) patients with p-value of 0.031. Conclusion: it is concluded that aprepitant and dexamethasone combination has higher efficacy as compared to metoclorpromide and dexamethasone in prevention of post-operative nausea and vomiting in elective laparoscopic cholecystectomy.

Effect of Anti-Emetic Combination of Sevoflurane / Propofol Anesthesia Technique in Laparoscopic Cholecystectomy

Objective: To assess symptoms of nausea and vomiting in laparoscopic cholecystectomy post-operatively, administered anesthesia by sevoflurane or propofol and to assess the effect of dexamethasone and ondansetron anti-emetic combination. Study design & Setting: It was an experimental study design conducted from 08-Oct-2017 till 11-Jul-2018 at Rawal General & Dental Hospital. Methodology: Patients were recruited in interventional groups by lottery method as n=160, with 80 cases allocated in each group. The patients with gallstones planned for laparoscopic cholecystectomy after preoperative assessment were classified to American Society of Anesthesiologist (ASA) physical status class I-II. All the patients placed in a particular ASA physical status class were (exposed to both induction methods) either anesthetic induction by propofol 1-2 mg/kg (group-A) or by employing sevoflurane 4-8% (group-B) in combination with oxygen, while maintenance was done in both study groups with 2% sevoflurane and 50% nitrous oxide in oxygen. After procedure patients stayed in post-anesthesia care unit where intra-operative monitoring was evaluated. The primary end point of the study was to note the rate of nausea and vomiting in 24 hours interval after surgery. Results: Both sevoflurane and propofol are equally effective anesthetic induction agents. The same combination of dexamethasone and ondansetron was given to both groups and so the actual effect of both anesthesia drugs in terms of side effects were nullified. Conclusion: In laparoscopic cholecystectomy, both sevoflurane and propofol are good enough when administered with dexamethasone and ondansetron anti-emetic combination, for post-operative nausea and vomiting up to 24 hours observation time in study.

A Comparison of the Effects of Spinal Anaesthesia between Sitting and Lateral Positions in Patients Undergoing Hysterectomy Surgery

Aim: The main purpose of this present study is to determine the effects of sitting (S) and lateral (L) position during spinal anaesthesia on patient satisfaction, Post dural puncture headache (PDPH), Post-Operative Nausea and Vomiting (PONV). Study Design: Prospective comparative study Place and Duration of Study: Charusat Healthcare and Research foundation (CHRF), Changa, Gujarat, between September 2021 to November 2021. Methodology: A total of 50 female volunteers who were above the age of 18 years, had an American Society of Anaesthesiologist (ASA) status of I & II and those who have undergone hysterectomy surgery are included in this study. The patients were categorized into two groups, group S (n=25) and group L (n=25). Patients were asked about PONV 4 hours after surgery and the possibility of PDPH on post-operative days 1 and 2. The study was analysed by using descriptive statistics, chi-square and Kruskal-Wallis test. Results: When comparing the incidence of PDPH on post-operative day 1 and day 2, there is a statistically significant difference between the Sitting (group S) and Lateral decubitus (group L) groups (P-value= 0.14 and.001). On the other hand, there is no statistical significant difference found for PONV when compared between both the groups (P- value= .776). Conclusion: Spinal anaesthesia with lateral decubitus position has better outcomes than sitting position for the incidence of Post dural puncture headache. However, there is no difference in both groups for PONV.

Comparison of the Prophylactic Effect of Propofol, Dexamethasone and Ondansetron on Post-Operative Nausea and Vomiting in Elective Cesarean Section Under Spinal Anesthesia

Nausea, and vomiting are common complications in women undergoing cesarean section with spinal anesthesia. This study aimed to compare the propofol, dexamethasone, and ondansetron effects on nausea and vomiting. In this double-blind, randomized clinical trial study, 120 women aged 15 to 35 years candidates for cesarean section under spinal anesthesia were enrolled. Patients were randomly divided into four groups (three-drug groups and control group). Patients received 0.05 mg/kg ondansetron (group O), 0.1 mg/kg dexamethasone (group D), 0.2 mg/kg propofol (group P) and normal saline in controls (group C). Nausea and vomiting in recovery and 6 hours after surgery compared between groups. In recovery and 6 hours after surgery, both nausea and vomiting were the highest in group C while they were lowest in group O. the frequency of nausea was 11(36.7%) in both recovery and 6 hours after surgery, and the frequency of vomiting was 12(40%) and 10(33.3%) in the recovery and 6 hours after surgery respectively. Among three drug groups, nausea and vomiting were higher in group D in both the recovery room and 6 hours after surgery. The frequency of vomiting was 10 (33.3%) and 5 (16.7%) in recovery and 6 hours after surgery in group D, respectively. These differences were statistically significant between the four groups (P<0.05). The preventive effect of dexamethasone is not very useful in both periods. Therefore, it can be recommended that in the short period after surgery, propofol has a beneficial effect in preventing postoperative nausea and vomiting.

Dexmedetomidine, Ketamine and Lidocaine Infusion for Prevention of Postoperative Nausea and Vomiting in Laparoscopic Gynecological Surgery: Randomized Trial

Background: The intraoperative use of large bolus doses or continuous infusions of potent opioids may be associated with increased analgesic consumption postoperatively. In ambulatory surgery, opioid related side effects, such as postoperative nausea and vomiting (PONV), prolonged sedation, ileus and urinary retention may delay recovery and discharge or cause unanticipated hospital readmission. The aim was to evaluate the effect of opioid sparing technique via infusion of dexmedetomidine, ketamine and lidocaine on post-operative nausea and vomiting in laparoscopic gynecological surgery. Methods: A total of 80 patients were randomly allocated into 2 groups, 40 patients each. Control group (group c) received fentanyl while, Study group (group S) received infusion of a mixture of dexmedetomidine, ketamine and lidocaine. The PONV impact scale, intraoperative consumption of isoflurane and fentanyl and post operative 24 hr. morphine consumption were measured. Results: 18 (45%) patients of control group experienced PONV versus 7 (17.5%) patients of study group and it was clinically significant. Clinically significant vomiting was observed in10 (25%) patients of control group and 1 (2.5%) patient of study group. There was a marked reduction in fentanyl, isoflurane and 24 hours’ morphine consumption in group S compared to group C. Conclusion: Opioid sparing anesthesia with dexmedetomidine, ketamine and lidocaine infusion are superior to fentanyl for prevention of post-operative nausea and vomiting and reduction of isoflurane and, fentanyl consumption and provides better patient satisfaction in laparoscopic gynecological surgery.

Granisetron Versus Ondansetron for Prevention of Post-operative Nausea and Vomiting (PONV) in Patients Undergoing Laparoscopic Cholecystectomy

Aim: To determine the efficacy of single dose Granisetron versus ondansetron in preventing PONV in patients undergoing elective laparoscopic cholecystectomy. Methodology: A total of 100 patients were included in this study after the ethical approval of PUMHSW. Patients were randomly divided into two groups, in (Group G) 50 patients were given Granisetron and in (group O) 50 patients were given Ondansetron. Every patient was evaluated for PONV at one hour, two hours, three hours, six hours, twelve hours and 24 hours post operatively. Results: A sample of 100 patients with age between 20-60 years (mean age 43.72±5.67 years), were included in this study. Patients were received granisetron 1 mg I/V and other patients received ondansetron 4mg I/V before induction. Conclusion: we concluded that there was no significant difference between efficacy of granisetron and ondansetron as the p-value is found to be ≤0.05.

A comparative study of propofol based total intravenous anesthesia and sevoflurane based volatile induction and maintenance anesthesia on post-operative recovery profile in elective tonsillectomy

Background: Tonsillectomies are common surgeries in day-to-day surgery practice particularly in pediatric age group. Recent trend is to conduct tonsillectomy surgery on a day care basis. It is important to use the best anesthetic option with the least recovery time to reduce the hospital stay of patient. Aims and Objectives: The aim of the study was to compare recovery profile and side effects of Sevoflurane and Propofol as an anesthetic agent for tonsillectomy. Materials and Methods: A total of 60 patients undergoing elective tonsillectomy were selected for the study. Each patient was randomly allocated to either the propofol (Group P) or the sevoflurane group (Group S). Time of surgery (From start to end of surgery), time of anesthesia (From the start of induction to end of surgery), time between the end of anesthesia and the spontaneous eye opening, and time between the end of anesthesia and the following of verbal commands. Time to extubation, time between the end of anesthesia, and the orientation to his or her name and the incidence of post-operative nausea and vomiting were compared in both the groups. Results: The eye opening in Group P patients was found to be 8.9+1.21 min and that in Group S was 6.6+1.25 which was found to be statistically significant. The following of verbal commands in Group P was found to occur at 10.13+1.28 min, while that in Group S was found to be at 7.63+1.25 min, which was statistically significant. The time for extubation in Group P was found to be 11.17+1.29 min, while that in Group S was found to be 8.67+1.24 min, which was statistically significant. The duration for complete orientation in Group P was found to be 12.2+1.27 min, while that in Group S was found to be 9.43+1.04 min, which came out to be statistically significant. Hemodynamic parameters were found to be comparable in both the groups with no statistically significant difference in between then at any point of time (P>0.05). Conclusion: Sevoflurane is a useful alternative to propofol in providing anesthesia where rapid emergence and recovery of cognitive functions are desired.

Comparison of Dexamethasone with Ondansetron for Prevention of Post-Operative Nausea and Vomiting

Objective: To examine the effectiveness of dexamethasone and ondansetron in reducing the incidence of post-operative nausea and vomiting (PONV) in patients following laparoscopic surgery. Patients and Methods: A total number of 100 patients who were planned for laparoscopic surgery under general anesthesia having age 20-60 years were included in this study from a tertiary care hospital from Dec-2019 to June-2021. Patients were divided in to two group using Draw randomization technique. Group I; in these patients IV dexamethasone 8 mg was given at the time of induction of anesthesia. Group II; in these patients Ondansetron (4 mg IV) was given at induction of anesthesia. After completing the surgery and shifting the patient to the recovery room frequency of PONV within 6 hours after surgery was noted. Results: Mean age of the patients was 43.31±10.41 years. There were 54 (54.00%) male patients and 46 (46.00%) female patients. There were 75 (75.00%) patients with ASA I and 25 (25.00%) patients with ASA II. PONV occurred in 11 (22.00%) patients in dexamethasone group and in 21 (42.00%) patients in ondansetron group (p-value 0.03). Conclusion: After laparoscopic surgery, dexamethasone decreased the prevalence of nausea and vomiting. A single dosage of dexamethasone was proven to be a safe and cost-effective alternative to a single dose of ondansetron. Keywords: Dexamethasone, Ondansetron, post-operative Nausea and vomiting.

The Correlation between Intra-Arterial Partial Pressure of CO2 (PaCO2) and Post-Operative Nausea, Vomiting (PONV) and Pain in Patients Undergoing Laparoscopic Cholecystectomy

Background: Postoperative nausea and vomiting is a common complication after surgery that no single theory has been expressed as to the cause of this complication so far. The aim of this study was to determine the relationship between PaCO2 and nausea, vomiting and pain after laparoscopic cholecystectomy. Methods: In this cross-sectional study, 88 patients in Alzahra hospital, underwent laparoscopic cholecystectomy were selected and the level of pre and postoperative PaCO2, as well as duration of postoperative nausea, incidence of vomiting, and severity of postoperative pain was assessed. The correlation between PaCO2, HCO3 and PH with these postoperative complications were evaluated. The patients’ data were analyzed by using Chi-square, t-test, Pearson correlation, Paired t-test and Repeated Measure ANOVA tests. P value < 0.05 was considered statistically significant. Results: The correlation between duration of nausea and PaCO2 levels before and after surgery was 0.05 and 0.04, respectively, which was not statistically significant (p value = 0.63 and p value = 0.72, respectively). In addition, the correlation between PaCO2 level and severity of postoperative pain was 0.2 (p value = 0.07), which was not statistically significant. Conclusion: The findings of the present study showed that PaCO2 level has not statistically significant effect on duration of postoperative nausea, incidence of vomiting, and severity of postoperative pain.

Ondansetron for Prevention of Post-Operative Nausea and Vomiting (PONV) in General Surgery Patients

Aim: To determine the efficacy of single dose ondansetron in preventing PONV in patients. Methodology: In this cross sectional study 49 patients were given Ondansetron. Every patient was evaluated for PONV at 1, 2, 3, 6, 12 and 24 hours post operatively. This study was conducted at General surgery operation theatres and surgical wards I, II, III and Department of Anesthesia and SICU Peoples University of Medical & Health Sciences for women Nawabshah, District Shaheed Benazirabad, Sindh. Results: A sample of 49 patients with age between 20-60 years (mean age 43.72±5.67 years), 35% male and 65% female was included in this study. In this study ondansetron was given (N=49) 4 mg I/V before induction. Regarding complications there was not significant (p ≤0.05) POVN was observed. Conclusion: Our study results showed in patients who received ondansetron regarding frequency of post operative complications (PONV) showed insignificant results as no p-value is found to be ≤0.05.It was concluded that a single dose of ondansetron is very effective in preventing PONV in general surgery patients.