The effect of granisetron dexamethasone combination on postoperative nausea and vomiting in gynecological operations

Year 2010, Volume: 37 Issue: 2, 109 - 114, 01.06.2010

Ziya Kaya Sedat Kaya Gönül Ölmez

Abstract

Objectives: Postoperative nausea and vomiting (PONV) is one of the most frequent adverse effects of anesthesia. PONV postpones hospital stays and also delays recover and getting better, of the patients. The objective of the current study is to compare efficacy of prophylactic gran­isetron (40 μ/kg) + dexamethasone (4 mg) combination against PONV in different anesthesia models. Materials and Methods: 72 patients with an age range of 18-72 years and ASA 1 or 2 were enrolled in the present study. The patients were assigned as group 1 propofol-remifentanil (P-R), group 2 propofol- nitrous oxide (P-N2O), group 3 sevoflurane- nitrous oxide (S-N2O) and group 4 sevoflurane-remifentanyl-air (S-R+H). Inductions of the patients in all groups were made with intravenous 2-3 mg/kg propofol, 1μ/kg remifentanil and 0.2 mg/kg cis-atracurium. 4 mg of dexamethasone by bolus and 40 μ/kg of granisetron by infusion were administered to the patients in all groups after induction. During the last 10 minutes of the operation, 1mg/kg tramadol was adminis­tered. Postoperative nausea and vomiting, VAS scores, and additional antiemetic needs were recorded during postoperative 48 hours. Results: Postoperative 48 hours follow up revealed that PONV was seen 27%, 16%, 38%, 48% frequencies in (P+R), (P+ N2O), (S+ N2O), (S+R+H) groups, respec­tively. While antiemetic requirement was not observed in (P+ N2O) and (S+ N2O) groups, the patients in (P+R) and (S+R+H) groups needed additional antiemetic drugs with a frequency of 5.5% and 11% respectively. Conclusion: Granisetron, dexamethasone combination in different anesthetic models did not reveal significant difference in terms of postoperative nausea, vomiting, and additional antiemetic usage.

Keywords

Nausea, vomiting, granisetron, dexametha­sone, gynecological operation, postoperative.

Granisetron-deksametazon kombinasyonunun jinekolojik girişimlerde postoperatif bulantı ve kusma üzerine etkileri

Abstract

Amaç: Postoperatif bulantı-kusma (POBK) anestezi son­rası en sık ortaya çıkan yan etkilerden biridir. POBK has­tanın ameliyat sonrası derlenmesini, düzelmesini ve has­tanede kalış süresini uzatır. Çalışmamızın amacı POBK\'yı önlemeye yönelik proflaktik olarak kullanılan granisetron (40 μ/kg) + deksametazon (4 mg) kombinasyonunun fark­lı anestezi modellerindeki etkinliğini araştırmaktır. Gereç ve Yöntem: Çalışmaya ASA 1–2 grubu, yaşları 18–70 arasında jinekolojik operasyon geçirecek 72 hasta alındı. Hastalar, Grup1 propofol-remifentanil (P-R), Grup 2 propofol-azot protoksit (P-N2O), Grup 3 sevoflurane- azot protoksit (SN2O), Grup 4 sevoflurane-remifentanil-hava (S-R+H) olmak üzere randomize 18\'erlik dört eşit gruba ayrıldı. İndüksyonda tüm gruplara 2-3 mg/kg propofol, 1 μ/kg remifentanil ve 0,2 mg/kg cis-atracuryum intravenöz verildi. Tüm gruplardaki hastalara indüksiyondan sonra 4 mg deksametazon bolus, 40 μ/kg granisetron infüzyon şeklinde (3 dk da) verildi. Postoperatif 48 saat hastaların bulantı-kusma, VAS skorları, ek antiemetik gereksinimleri kaydedildi ve oprasyonun son 10 dakikasında 1mg/kg tra­madol intravenöz uygulandı. Bulgular: Kırk sekiz saatlik takiplerde POBK, grup I (P+R)\'de %27, grup II (P+ N2O)\'de %16, grup III (S+ N2O)\'de %38 ve grup IV (S+R+H)\'de %48 oranında görül­dü. Grup (P+ N2O) ve grup (S+ N2O)\'de antiemetik gerek­mezken, grup (P+R); %5.5 ve grup (S+R+H)\'de ise; %11 oranında antiemetik gereksinimi oldu. Sonuç: Sonuç olarak jinekolojik operasyonlarda, değişik anestetik modellerde uygulanan granisetron, dexame­tazon kombinasyonu postoperatif bulantı, kusma ve ek antiemetik gereksinimi açısından anlamlı bir farklılık gös­termedi.

Keywords

Bulantı kusma, granisetron, deksa­metazon, jinekolojik operasyon, ameliyat sonrası

References

• Lerman J. Surgical and patient factors involved in postop- erative nausea and vomiting. Br J Anaesth 1992;69 (suppl 1):24-32.
• Camu F, Lauwers MH, Verbessem D. Incidence and aetiol- ogy of postoperative nausea and vomiting. Eur J anaesthe- siol 1992;9 (suppl 6):25-31.
• Rabey PG, Smith G. Anaesthetic factors contributing to postoperative nausea and vomiting. Br J Anaesth 1992;69 (suppl 1):40-5.
• Watcha MF. The cost-effective management of postoperative nausea and vomiting. Anesthesiology 2000;92:931-4.
• Rowbotham DJ. Current management of postoperative nau- sea and vomiting. Br J Anaesth 1992;69 (suppl 1):46-59.
• Sinclair DR, Chung F,Mezei G. Can postoperative nausea and vomiting be predicted? Anesthesiology 1999;13:109- 18.
• Cohen MM, Duncan PG, DeBoer DP, et al. The postoperative interview: assessing risk factors for nausea and vomiting. Anesth Analg 1994; 78:7-16.
• Koivuranta M, Laare E, Snare L, et al. A survey of postopera- tive nausea and vomiting. Anaesthesia 1992; 77:162-184
• Liu K, Hsu CC, Chia YY. The effective dose of dexame- thasone for antiemesis after major gynecological surgery. Anesth Analg 1999;89,1316-8.
• Mikawa K, Takao Y, Nishina K, Shiga M, Maekawa N, Obera H. Optimal dose of granisetron for prophylaxis againts postoperative emesis after gynecological surgery. Anesth analg1997;85:652-6.
• Liu K, Hsu CC, Chia YY. Effect of dexamethasone on post- operative emesis and pain. Br J Anaesth 1998;80.85–6.
• Goldfien A. Adrenocorticosteroids and adrenocortical antagonists. In: Katzung BG, ed.Basic and clinical Phar- macology, 7th edition. Connecticut, Stamfort: Appleton& Lange, 1998:635–43.
• Hammas B, Thorn SE, Wattwil M. Superior prolonged an- tiemetic prophylaxis with a four drug multimodal regimen- comparison with propofol or placebo. Acta Anaesthesiol Scand 2002;46.232-7.
• Paech MJ, Lee BHS, Evans SF. The effect of anaesthetic technique or postoperative nausea and vomiting after day- case gynaecological laparoscopy. Anaesth Intensive Care 2002;30.153-9.
• Özköse Z, Yalçın cok O, Tuncer B, Tüfekçioğlu S, Yardım Ş. Comparison of hemodynamics, recovery profile and early postoperative pain control and costs of remifentanil versus alfentanil-based total intravenous. J Clin Anesthesia 2002;14.161-8.
• Visser K, Hassink AE, Bonsel GJ, Moen J, Kalkman C. Randomized controlled trial of total intravenous anesthesia with propofol versus inhalation anesthesia with isoflurane- nitrous oxide. Anesthesiology 2001;95.616-26.
• Yoshitaka F, Hiroyoshi T, Hidenori T. The effect of dex- amethasone on antiemetics in female patients undergoing gynecologic surgery. Anesth Analg 1997;85.913-7.
• Erikson H, Kortilla K. Recovery profile after desflurane with or without ondansetron compared with propofol in patients undergoing outpatients gynecological laparoscopy. Anesth Analg 1996;82.533-8.
• Grundman U, Silomon M,Back F, et al. Recovery profile and side effects of remifentanil-based anesthesia with des- flurane or propofol for laparoscopic cholecystectomy. Acta Anaesthesiol Scand 2001;45.320-6.
• White PF, Watcha MF. Postoperative nausea and vom- iting prophylaxis versus treatment. Anesth Analg 1999;89,1337-9.
• Akaya T, Sayın MM, Temizsoylu M, et al. Granisetron ve Granisetron Deksametazon’un Postoperatif antiemetik ve analjezik özelliklerinin karşılaştırılması. Türk Anest Rean Cem Mecmuası 2001;29.113-7.
• Fuji Y, Tanaka H, Toyooka H. Prophylactic antiemetic therapy with granisetron-dexamethasone combinationin women undergoing breast surgery. Acta Anaesthesiol Scand 1998;42,1038-42.
• Erhan Y, Erhan E, Aydede H, Yumus O, Yentur A. Ondanse- tron, granisetron, and dexamethasone compared for thep- revention of postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy. Surg Endosc 2008;22:1487-92
• Moussa AA, Oregan PJ. Prevention of postoperative nau- sea and vomiting in patients undergoing laparoscopic bar- iatric surgery-granisetron alone vs granisetron combined with dexamethasone/droperidol. Middle East J Anesthesiol 2007;19:357-67.