Purpose: To determine the efficacy of ondansetron and droperidol, alone and in combination, administered for prophylaxis of postoperative nausea and vomiting (PONV) in women undergoing general anesthesia for outpatient gynecological laparoscopy.Methods: Following Institutional Ethics Board approval and patient consent, 160 female out-patients scheduled for laparoscopy were randomly allotted in a double-blind fashion to receive: i) saline (placebo), ii) 4 mg ondansetron, iii) 1.25 mg droperidol, or iv) 4 mg ondansetron and 1.25 mg droperidol combination intravenously on induction. Following a standardized general anesthesia, patients were interviewed and assessed for PONV at various times.Results: During the first 24 hr after surgery, the incidence of PONV in the placebo group was 71%. This was reduced to 61% with droperidol alone (P = 0.334), to 46% with ondansetron alone (P = 0.027), and to 23% with the combination group (P < 0.001). A statistically significant difference was observed between combination and droperidol (P < 0.001) and between combination and ondansetron (P = 0.036). There were fewer requests for rescue medication from the combination group (7.7%) than from the ondansetron and placebo groups. Conclusion:The results of this study suggest that the combination of 4 mg ondansetron and 1.25 mg droperidol is more efficacious as a prophylactic anti-emetic than either agent alone during the 24 hr post-surgery. This additive effect may be due to the different mechanisms of action of ondansetron and droperidol.Objectif : Déterminer l'efficacité de l'ondansétron et du dropéridol, seuls ou combinés, administrés comme prophylaxie des nausées et vomissements postopératoires (NVPO) chez des patientes sous anesthésie générale lors d'une laparoscopie gynécologique en clinique externe.Méthode : Après avoir obtenu l'autorisation du Comité d'éthique médicale et le consentement des patientes, on a procédé à l'étude de 160 femmes, réparties au hasard en double aveugle, qui ont reçu avant la laparoscopie ambulatoire prévue : i) une solution salée (placebo), ii) 4 mg d'ondansétron, iii) 1,25 mg de dropéridol, ou iv) une combinaison intraveineuse de 4 mg d'ondansétron et de 1,25 mg de dropéridol à l'induction de l'anesthésie. Après l'anesthésie générale standard, les patientes ont été interrogées sur les NVPO à différents temps.Résultats : Pendant les 24 premières heures postopératoires, l'incidence des NVPO ont été de 71 % dans le groupe placebo. Cette incidence a été réduite à 61% avec de dropéridol employé seul (P = 0,334), à 46 % avec l'ondansétron seul (P = 0,027) et à 23 % avec la combinaison des deux médicaments (P < 0,001). Une différence statistiquement différente a été observée entre la combinaison et le dropéridol (P < 0,001) et entre la combinaison et l'ondansétron (P = 0,036). On enregistre moins de demandes de médication de rattrapage provenant des patientes qui ont reçu la combinaison de médicaments (7,7 %) que de celles qui ont reçu l'ondansétron ou le placebo.Conclusion : Les résultats de l'étude suggèr...

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MIdazolam has been shown to interact synergistically with propofol during "co.induction" of anaesthesia. I However, it is uncertain whether mldazolam affects propofol requirements during, and recovery times following, total Intravenous anaesthesia (TIVA) In Day Care patients. A double-blind study was therefore designed to determine these effects. Here, we deacdbe unexpected cases of awareness with recall In our study population. METHODS: Ninety unpremedlcated ASA Class I and II adult Day Care patients, 'scheduled to undergo either knee erthreacepy or laparoscoplc procedures, gave written consent to the protocol approved by the hospital REB. Patients received, in a random fashion, either placebo (Group PLAC) or midazolam at a dose of 0.015 ms-ks "~ (Group MID-15), 0.030 mg.kg "~ (Group MID.30) or 0.045 rag.ks "~ (Group MID-45) prior to Induction of anaesthesia. Anaesthesia was then Induced with propofol 0.8-1.5 rag.ks "1 an.d alfantanil 20 Fg.kg "l, and alracurlum 0.5 mg.kg "1 to facilitate tracheal Intubatlon. Anaesthesia was malntalnad with a continuous Infusion of propofol beginning at 100 p.g.kg't.min "t, titrated as required to maintain HR and SBP within =2.0% of the patient's normal values, or in response to patient movement, while atfentanll was Infused st 0.5 Fg.kg'l.mln "~ (constant). Times to awakening ware compared postoperatively. In addition, a follow-up questionnaire, designed to evaluate the overall quality of the anaesthetic experience, was completed for each patient on the first post-operative day. Data were analyzed using the Chlsquare statistic and Flscher's Exact test where appropriate, with significance assumed when P<0.05 RESULTS: Propofol Infusion requirements varied significantly from one patient to another (range 80-280 ug.kg't.min'l), but cumulative requirements were not different between groups~ Rapid awakening was observed in all four groups (5=3, 4=2, 6==3 and 6• rain for groups PLAC, M-15, M-30 andM-45, respaotively). Unexpectedly, however, six patients experienced awareness with recall using this technique (4 of 23 patients in the PLAC group compared with 2 of 67 patients in the mldezolam treatment groups, P<0.02, Table). Five of the 6 patients experienced mild or moderate pain with their re(all, but no patient described any psychologlcat distress or anxiety, In fact, despite their ~perlence of awareness, 3 of the 6 patients related the quality of this anaesthetic to heve been superior to their last anasst hotic, For ethical reasons, the study was stopped. DISCUSSION: Despite the high quality of recovery, TIVA was associated with an unacceptably high incidence of awareness with recall In this study. This may have been due, In part, to the relatively low initial infusion rate of propofoL We unexpectedly found that low dose mldazolam (0.015-0,045 rag.ks "t) reduces the likelihood of intraoperative awareness, without prolonging recovery times REFERENCE: