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

Yıl 2017, Cilt: 9 Sayı: 4, 177 - 182, 01.12.2017

Ayça Tuba Dumanlı Özcan , Erdal Özcan Ebru Çanakçı Korhan Kılıç

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

Öz

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. 

Anahtar Kelimeler

Nausea Vomiting, Adenotonsillectomy, Midazolam

Adenotonsillektomi sonrasında gelişen postoperatif bulantı kusmayı önlemede proflaktik midazolam kullanımı

Öz

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.

Anahtar Kelimeler

Bulantı-Kusma, Adenotonsillektomi, Midazolam

Kaynakça

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