Prophylactic Midazolam For Prevention Of Post-Operative Nausea And Vomiting Following Adenoidectomy or Adenotonsillectomy

Year 2017, , 177 - 182, 01.12.2017

Ayça Tuba Dumanlı Özcan , Erdal Özcan Ebru Çanakçı Korhan Kılıç

https://doi.org/10.21601/ortadogutipdergisi.279714

Abstract

Objective: Postoperative nausea and vomiting (PONV) is a common
complication after tonsillectomy. Midazolam is known to decrease postsurgical
vomiting. In this study, we investigate the effect of intramuscular Midazolam
on postoperative nausea vomiting in children undergoing adenoidectomy
or adenotonsillectomy.

Material and Method: In a randomized double-blind study, we evaluated 66
healthy children, aged 5–12 years, who underwent adenoidectomy with or without
tonsillectomy. Afterwards, anesthesia was induced by inhalation of sevoflurane,
rocuronium bromide 0.6 mg kg^–1, and fentanyl
1 µg kg^–1, and
anesthesia was maintained by sevoflurane for all patients. Patients were administered subcutaneous morphine 0.1 mg kg^–1
for postoperative analgesia. Patient’s in-Group II were administered
intramuscular midazolam 0.1 mg kg^–1. The incidence of
nausea/vomiting and antiemetic requirement 0-4 h and 4-24 h post surgery was
recorded. Data for
postoperative vomiting were grouped into the following time periods: 0–4 and
4–24 h. Data were analyzed using a Student’s t-test and chi-squared analysis.

Results: No statistically significant different was found between groups in 0-4,
and 4-24 hours in terms of median VAS levels (p=0,883 and p=0,881). Although
Group II had lower incidence of nausea both in 0-4 and 4-24 hours compared to
Group I, there was no statistically significant difference between the groups (p=0,618
and p=0,28). There was no statistically significant difference between the
groups in 0-4, and 4-24 hours in terms of median nausea VAS levels (p=0,597 and
p=0,982). There was also no statistically significant difference between the
groups in terms of rates of additional analgesic requirement in 24 hours, and
median additional analgesic number (p=0,197 and p=0,865). Antiemetic
requirement rates in 24 hours in Group II were lower at a statistically
significant rate compared to Group I (p=0,027). Yet, there was no statistically
significant difference between the groups in terms of median antiemetic number
in 24 hours (p=0,070).

Conclusion: For children undergoing tonsillectomy, intraoperative
midazolam treatment does not provide a prophylaxis against postoperative
vomiting. 

Keywords

Nausea Vomiting, Adenotonsillectomy, Midazolam

Adenotonsillektomi sonrasında gelişen postoperatif bulantı kusmayı önlemede proflaktik midazolam kullanımı

Abstract

Amaç: Postoperatif bulantı kusma tonsillektomi sonrası
en yaygın komplikasyondur. Biz de çalışmamızda adenotonsillektomi veya
adenoidektomi olan çocuklarda intramuskuler midazolamın postoperatif bulantı
kusmaya proflaktik etkisini araştırmayı amaçladık.
Gereç ve Yöntem: Çalışmaya 5-12 yaş arasında sağlıklı adenotonsillektomi
veya sadece adenoidektomi olacak 66 çocuk randomize ve çift kör olarak
çalışmaya dahil edildi. Sevofluran inhalasyonunu, 0.6 mgkg-1 rokuronyum bromid
ve 1µg kg–1 fentanil lie anestezi indüksiyonunu takiben tüm olgularda idame
sevofluran inhalasyon anestezisi ile sağlandı. Tüm hastalara subkutanöz morfin
0.1 mg kg–1 postoperatif analjezi amaçlı uygulandı. Grup II'de yer alan
hastalara aynı standart anestezi protokolü yanında im midazolam 0.1 mg kg–1
entübasyon sonrası uygulandı.   Postoperatif   kusma verileri  0-4 ve  4-24. saat  periotlarında   gruplandırıldı.  Veriler

Student t-testi ve Chi-squared testi ile analiz
edildi.
Bulgular: Gruplar arasında 0-2 ve 2-24. saatlerde medyan VAS düzeyleri yönünden
istatistiksel olarak anlamlı farklılık görülmedi (p=0,883 ve p=0,881). Gruplar
arasında 24 saatte ek analjezik gereksinim oranları ve medyan ek analjezik
sayısı yönünden de istatistiksel olarak anlamlı farklılık görülmedi (p=0,197 ve
p=0,865). Grup I'e göre Grup II'de 24 saat antiemetik gereksinim

oranı istatistiksel anlamlı olarak daha düşüktü
(p=0,027). 
Sonuç: Adenotonsillektomi  olacak  çocuklarda  intraoperative  sadece  midazolam
 tedavisinin

postoperatif kusmaya karşı korucu olamadığı
düşüncesindeyiz.

Keywords

Bulantı-Kusma, Adenotonsillektomi, Midazolam

References

• 1- Guida RA, Mattucci KF. Tonsillectomy and adenoidectomy: an inpatient or out patient procedur? Laryngoscope 1990; 100 (5): 491–493.
• 2- Carithers JS, Gebhart DE, Williams JA. Postoperative risks of pediatric tonsilloadenoidectomy. Laryngoscope 1987; 97 (4): 422–429.
• 3- Fazi L, Jantzen EC, Rose JB, Kurth CD, Watcha MF. A comparison of oral clonidine and oral midazolam as preanesthetic medications in the pediatric tonsillectomy patient.Anesth Analg 2001; 92 (1): 56-61.
• 4- Apfel CC, Läärä E, Koivuranta M, Greim CA, Roewer N. A sim- plified risk score for predicting postoperative nausea and vom- iting: conclusions from cross-validations between two centers. Anesthesiology 1999; 91 (3): 693–700
• 5- Baines D. Postoperative nausea and vomiting in children. Pediatric Anaesth.1996; 6 (1): 7-14.
• 6- Mowafi AH, Telmessani L, Ismail S A, Naguib MB. Preoperative lornoxicam for pain prevention after tonsillectomy in adults. Journal of Clinical Anesthesia 2011; 23 (2): 97–101
• 7- Anderson BJ, Ralph CJ, Stewart AW et al. The dose-effect relationship for morphine and vomiting after day-stay tonsillectomy in children. Anaesth Intensive Care 2000; 28 (2): 155–160.
• 8- Herreen PG, Wiese MC. Concealed post-tonsillectomy haemorrhage associated with the use of the antiemetic tropisetron. Anaesth Intensive Care 2001; 29 (4): 421–422.
• 9- Gan TJ, Diemunsch P, Habib AS et al. Consensus Guidelines for the Management of Postoperative Nausea and Vomiting. Anesthesia & Analgesia 2014; 118 (1): 85 – 113.
• 10- Azim H, Mohammadreza S, Gholamreza K, Fatemeh M. Prophylactic administration of haloperidol plus midazolam reduces postoperative nausea and vomiting better than using each drug alone in patients undergoing middle ear surgery. Saudi J Anaesth 2012; 6 (2): 145–151.
• 11- Huh BK, Jung S, White W, Jeon Y. Antiemetic effect of midazolam added to patient-controlled analgesia after total abdominal hysterectomy. Anaesth Intensive Care. 2010 May; 38 (3): 481-5.
• 12- Furst SR, Rodarte A. Prophylactic antiemetic treatment with ondansetron in children undergoing tonsillectomy. Anesthesiology 1994; (81): 799–803.
• 13- Bolton CM, Myles PS, and Nolan T et al. Prophylaxis of postoperative vomiting in children undergoing tonsillectomy: a systematic review and meta-analysis. Br J Anaesth 2006; (97):593–604.
• 14- Erk G, Örnek D, NF Dönmez, Taşpınar V. The use of ketamine or ketamine—midazolam for adenotonsillectomy. International Journal of Pediatric Otorhinolaryngology 2007; (71): 937-941.
• 15- Fujii Y, Itakura M. A prospective, randomized, double blind, placebo-controlled study to assess the antiemetic effects of midazolam on postoperative nausea and vomiting in women undergoing laparoscopic gynecologic surgery. Clin Ther 2010; (32): 1633-7.
• 16- Splinter WM, MacNeill HB, Menard EA, et al. Midazolam reduces vomiting after tonsillectomy in children. Can J Anaesth 1995; (42): 201–203.
• 17- Ha JH, Kwak KH, Seo JW, et al. Effectiveness of ondansetron and midazolam in the prevention of PONV after thyroidectomy. Korean J Anesthesiol 2007; (53): 344–349.
• 18- Unlugenc H, Guler T, Gunes Y, et al. Comparative study of the anti-emetic efficacy of ondansetron, propofol and midazolam in the early postoperative period. Eur J Anaesthesiol 2004; (21): 60–65
• 19- Safavi MR and Honarmand A. Low dose intravenous midazolam for prevention
• 20- Patel SI, Birnbaum AK, Cloyd JC, Leppik IE. Intravenous and Intramuscular Formulations of Antiseizure Drugs in the Treatment of Epilepsy.CNS Drugs. 2015 Dec;29 (12):1009-22. doi: 10.1007/s40263-015-0289-0.
• 21- Kim WJ, Kang H, Shin HY, Baek CW, Jung YH, Woo YC, Kim JY, Koo GH. Ramosetron, midazolam, and combination of ramosetron and midazolam for prevention of postoperative nausea and vomiting: a prospective, randomized, double blind study. J Int Med Res. 2013 Aug; 41 (4):1203-13.
• 22- Park EY, Lee SK, Kang MH, Lim KJ, Kim YS, Choi E, Park YH. Comparison of ramosetron with combined ramosetron and midazolam for preventing postoperative nausea and vomiting in patients at high risk following laparoscopic gynaecological surgery. J Int Med Res. 2013 Jun; 41 (3):654-63.
• 23- Honarmand A, Safavi M, Khalili G, Mohammadnejad F. Prophylactic administration of haloperidol plus midazolam reduces postoperative nausea and vomiting better than using each drug alone in patients undergoing middle ear surgery. Saudi J Anaesth 2012; (6): 145-51
• 24- Jang JS, Lee JH, Lee JJ,Park WJ,Hwang SM, Lee SK, Lim SY.Postoperative Nausea and Vomiting after Myringoplasty under Continuous Sedation Using Midazolam with or without Remifentanil. Yonsei Med J 2012; (53): 1010-1013.
• 25- Sanjay OP, Tauro DI. Midazolam: an effective antiemetic after cardiac surgery – a clinical trial. Anesth Analg 2004; (99): 339–343.