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

Abstract

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...

Comparison of Ondansetron and Metoclopramide for PONV Prophylaxis in Laparoscopic Cholecystectomy

“…They also observed a lesser success rate in the prevention of PONV is poor in Ondansetron group as well [3]. Additional published studies support our deductions where a similar reduction in the incidence of PONV was observed during 24 hour post recovery period [22][23][24][25].…”

Anaesthesia for laparoscopic urological surgery

“…These were usually ketorolac 10-20 mg, ondansetron 4 mg and diamorphine 5-10 mg. Dexamethasone 4 mg was added for patients at high risk of postoperative nausea and vomiting. 10 Non-steroidal antiinflammatory drugs were avoided in patients with borderline renal function.…”

Measurement of Postdischarge Nausea and Vomiting for Ambulatory Surgery Patients: A Critical Review and Analysis

“…,33 Rajeeva et al 27 were the only investigators to rate the severity of vomiting by number of episodes over a 24-hour period other than Fetzer et al 22 who used the AS-INVR.…”