Author/Authors :
Abd El Azim, Ayman Abdul Shakour Al Azhar University - Faculty of Medicine (Male) - Department of Anesthesiology and Intensive Care, Egypt
Abstract :
Postoperative nausea and vomiting (PONV) remains a significant problem following general anesthesia in high-risk populations, such as females undergoing gynaecological laparoscopic operations, the incidence of this distressing adverse effect can be as high as 79%. A number of antiemetics have been used to prevent the occurrence of PONV. Aim of the Study: This study investigates the effectiveness of midazolam in combination with dexamethasone as antiemetic and compared with its efficacy with that of haloperidol in the prevention of PONV in patients undergoing gynecological laparoscopic operations. Our hypothesis was that midazolam with Dexamethasone were as effective antiemetic as Haloperidol in the prevention of PONV. Methods: 150 women outpatients aged 29 – 42. Patients were randomly divided into one of 5 groups (30 patients each); placebo, Dexamethasone 8 mg i.v., haloperidol 1mg i.v., midazolam 50 ug/kg^-1 and midazolam 50 ug/kg^-1 in combination with dexamethasone 50 ug/kg^-1 (maximum dose, 8mg). Parameters were recorded on arrival and every 30 min., or whenever PONV occurred during a period of 24h: nausea score, episodes of vomiting, sedation score, and visual analogue pain score (VAS) and adverse effects. The standard ECG lead II was continuously recorded at a paper speed of 25 mm/s and an amplification of 0.1 mV/mm for 3min. before and every 3 to 9 min. after injection of the study medication. Results: Thus, 30 patients in each group were analyzed for 24h following discharge from post-anesthesia care unit. Although the haloperidol group and midazolam Dexamethason group had lower overall incidences of nausea (3.33% and 3.33% respectively) and vomiting (0) compared with the control, dexamethasone and midazolam groups nausea (63.33%, 33.33% and 16.66%), and vomiting (40%, 23.33% and 13.33%) respectively. The QTc prolongation values in the haloperidol group were 433.2 ± 17.75 and 431.23 ± 17.07 ms at 3 and 6 min. after administration of the study medication compared with 222.66 ± 14.55 ms before study medication administration in same group. Conclusion: The combination of midazolam and dexamethasone in women undergoing laparoscopic gynecological surgery results in remarkable reduction of PONV during the first 24h following procedure without remarkable side effects.
