A Randomized Double-Blinded Comparison of Metoclopramide, Ondansetron and Cyclizine in Day-Case Laparoscopy

Watts, Steve

doi:10.1177/0310057x9602400506

Cited by 21 publications

(5 citation statements)

References 21 publications

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“…We have demonstrated that the incidence of PONV after day‐case gynaecological laparoscopy is > 50% despite the use of anti‐emetic prophylaxis (cyclizine = 56%, ondansetron = 54%) Our results are consistent with those found in other studies [8, 13, 16]. PONV occurs frequently after gynaecological laparoscopy and it is the commonest cause of admission after outpatient surgery [1].…”

Section: Discussionsupporting

confidence: 90%

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Comparison of cyclizine and ondansetron for the prevention of postoperative nausea and vomiting in laparoscopic day‐case gynaecological surgery

Grimsehl¹,

Whiteside²,

Mackenzie³

2002

Anaesthesia

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SummarySerum cholinesterase activity was measured at induction, and following anaesthesia in 41 children aged between 4 and 30 months. The median exposure to sevoflurane was 273%.min. The results did not demonstrate any significant difference in cholinesterase activity, when expressed by gram of serum proteins following inhalation anaesthesia using sevoflurane or intravenous anaesthesia using propofol. The values (SD) obtained were 175 (42) UI.g 21 before anaesthesia and 177 (43) UI.g 21 following anaesthesia. The only change in cholinesterase activity detected was related to heamodilution. We conclude that plasma fluoride concentration following sevoflurane administration [13.8 (4.2) m mol.l 21 ] is too low to exert an inhibiting effect on in vivo cholinesterase activity and that the previously reported decrease in mivacurium requirements during sevoflurane anaesthesia is unlikely to be due to inhibition by fluoride ions.Keywords Anaesthetics, volatile: sevoflurane. Enzymes: pseudocholinesterase. Previous studies have reported the potentiation of nondepolarising neuromuscular blockade by inhalation anaesthesia [1, 2]. Interactions between mivacurium and inhaled anaesthetics have also been described in children [3]. Neuromuscular recovery has been found to be prolonged in children receiving 0.2 mg.kg 21 mivacurium administered during 1 MAC sevoflurane anaesthesia [4]. The mivacurium infusion requirement to maintain constant neuromuscular blockade is reduced by sevoflurane when compared with propofol [5]. The short duration of action of mivacurium results from its rapid hydrolysis by plasma cholinesterase (ChE). Mivacurium requirements and recovery from neuromuscular blockade are well correlated in children with ChE activity measured immediately following induction of anaesthesia [5]. It has recently been shown that drug-induced inhibition of ChE activity reduces the clearance of the three isomers of mivacurium, causing a prolonged duration of its action and recovery time [6]. Sevoflurane undergoes hepatic biotransformation (2±5%) to hexafluoro-isopropanol and inorganic fluoride [7]. In vitro, fluoride ions at concentrations that have been reported during sevoflurane anaesthesia significantly inhibit ChE activity [8]. Therefore, this study was designed to test the hypothesis that the decrease of mivacurium requirements during sevoflurane anaesthesia is related to ChE inhibition by fluoride ions. MethodsFollowing institutional approval and informed parental consent, 52 children (18 female), ASA physical status I or II scheduled for elective surgery were enrolled in this prospective open, non-randomised clinical trial. Fortyone children (13 female) received inhalation induction of anaesthesia using sevoflurane (group S) and 11 children (5 female) acted as the control group and received intravenous anaesthesia using propofol (control group or group P). All children received midazolam (0.3 mg.kg 21 ) administered rectally 20 min before induction of anaesthesia. In group S, induction of anaesthesia was achieved using...

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Section: Discussionsupporting

confidence: 90%

“…In the day‐case setting, PONV prolongs hospital stay and significantly delays discharge [5, 6]. The intra‐operative use of anti‐emetic medication reduces the incidence of PONV [7, 8].…”

mentioning

confidence: 99%

Comparison of cyclizine and ondansetron for the prevention of postoperative nausea and vomiting in laparoscopic day‐case gynaecological surgery

Grimsehl¹,

Whiteside²,

Mackenzie³

2002

Anaesthesia

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“…22,26,38,[57][58][59] Three trials of cyclizine were reviewed. One showed no reduction in postoperative NV versus a control group 60 ; whereas the other 2 did find the drug as efficacious in reducing postoperative NV as ondansetron in ambulatory gynecologic laparoscopy. 20,61 A single study of ephedrine, given intraoperatively by intramuscular injection to patients undergoing gynecologic laparoscopy, was able to show a reduction in postoperative NV; however, this is the only randomized controlled trial that evaluated this medication in the laparoscopic population.…”

Section: Antiemetic Medicationsmentioning

confidence: 84%

Evidence-Based Practice in Laparoscopic Surgery: Perioperative Care

Goldfaden

Birkmeyer

2005

Surg Innov

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Best practices for reducing risks of postoperative infection, venous thromboembolism, and nausea and vomiting in patients undergoing laparoscopic surgery are uncertain. As a result, perioperative care varies widely. We reviewed evidence from randomized clinical trials on the effectiveness of interventions for postoperative infection, venous thromboembolism, and nausea and vomiting Data sources were the Cochrane Central Register of Clinical Trials, reference lists of published trials, and randomized clinical trials published in English since 1990. Trials were also limited to those focused on patients undergoing laparoscopic surgery. Data from 98 randomized clinical trials were included in the final analysis. Routine antibiotic use in laparoscopic cholecystectomy, and possibly other clean procedures not involving placement of prostheses, is likely unnecessary. Similarly, venous thromboembolism prophylaxis is probably unnecessary for low-risk patients undergoing brief procedures. Of a wide variety of methods for reducing postoperative nausea and vomiting, serotonin receptor antagonists appear the most effective and should be considered for routine prophylaxis.

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“…Although its antiemetic efficacy is under debate, some controlled trials performed during gynecological and obstetric procedures [38][39][40][41] showed that metoclopramide 10 mg is effective and safe. The anti-vomiting effect of metoclopramide was present only within 6 hours following its administration [15].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Efficacy of Metoclopramide, Dexamethasone and Their Combination for the Prevention of Postoperative Nausea and Vomiting (PONV) in Patients Undergoing Cesarean Section

Rasheed¹,

Sarkar²,

Arora³

2019

Anesth Crit Care

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Background: Nausea and/or vomiting following regional anaesthesia in pregnant females undergoing caesarean section is a major clinical problem. This study was conducted to compared the efficacy of metoclopramide, dexamethasone, and their combination for preventing intra operative & post-operative nausea and vomiting (PONV) following spinal anaesthesia given for caesarean section in patients. Materials and Methods: A total of 120 full term pregnant females of ASA I & II grade with uncomplicated pregnancies were included in this prospective randomized double blind study. Patients were randomly allocated to three groups. The group D (n= 40) received 8 mg dexamethasone, group M (n=40) received10 mg of metoclopramide while group D+M (n= 40) received 8 mg dexamethasone along with10 mg of metoclopramide intravenously immediately before administration of spinal anaesthesia. Intraoperative and post operative emetic episodes (nausea, retching, and vomiting) was noted as well as any other adverse effects. Results: During intraoperative period all parturients had PONV score 0. Postoperatively at first hour number of full responders in group D, M and D+M were 29/40 (72.5%), 30/40 (75%), 38/40 (95%) and the difference was statistically significant (Group D Vs Group D+ M, P value -0.013 and Group M Vs Group D+ M, P value-0.025). At 3rd hour postoperatively 9 patients in Group D, 8 patients in Group M and 1 in Group D+ M, had PONV score 1 (Group D Vs Group D+ M, P value -0.014 and Group M Vs Group D+ M, P value-0.029). No patient had any vomiting episodes over the time period of 24 hrs.

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A Randomized Double-Blinded Comparison of Metoclopramide, Ondansetron and Cyclizine in Day-Case Laparoscopy

Cited by 21 publications

References 21 publications

Comparison of cyclizine and ondansetron for the prevention of postoperative nausea and vomiting in laparoscopic day‐case gynaecological surgery

Comparison of cyclizine and ondansetron for the prevention of postoperative nausea and vomiting in laparoscopic day‐case gynaecological surgery

Evidence-Based Practice in Laparoscopic Surgery: Perioperative Care

Evaluation of Efficacy of Metoclopramide, Dexamethasone and Their Combination for the Prevention of Postoperative Nausea and Vomiting (PONV) in Patients Undergoing Cesarean Section

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