Effect of midazolam, dexamethasone and their combination on the prevention of nausea and vomiting following strabismus repair in children

Riad, Waleed; Altaf, Ramzan; Abdulla, A.; Oudan, H.

doi:10.1017/s0265021507000166

Cited by 31 publications

(30 citation statements)

References 23 publications

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“…Our findings in this regard were similar to the observation of those of Raid and Eberhart[3233] Both of these studies were done on children aged between 4–12 years old who had a high incidence of PONV, following strabismus repair surgery and anesthesia were induced and maintained by sevoflurane.…”

Section: Discussionsupporting

confidence: 91%

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Comparing the preventive effect of midazolam and midazolam-dexamethasone on postoperative nausea and vomiting in elective middle ear surgery

Heidari

Yaraghi

2012

Adv Biomed Res

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Background:Nausea and vomiting are common postoperative complications with incidence of 20–80% depends on the surgery type, anesthetic drugs, age, sex, etc. This complication may lead to patient discomfort, intraocular, and intracerebral pressures increase, sutures rupture, esophageal injury, and rarely death. Many studies reported that midazolam and dexamethasone alone can decrease postoperative nausea and vomiting (PONV), but their combination has never been studied yet. The aim of this study was to compare the effect of midazolam and midazolam-dexamethasone on PONV after middle ear surgery.Materials and Methods:66 ASA I and II patients aged 15–65 year scheduled for elective middle ear surgery under general anesthesia randomly divided into two groups. Immediately after induction of the anesthesia group one (M) received midazolam 0.075 mg/kg and group two (M+D) received combination of midazolam (0.075 mg/kg) plus dexamethasone (0.05 mg/kg). Then the severity of nausea was measured by visual analog scales 0–10 (VAS) in recovery room at 6, 12, and 24 h after surgery. Metoclopramid (0.1 mg/kg) was administrated I.V. slowly if nausea score was above 3 or patient had vomiting. The postoperative need for antiemetics and the duration of stay in recovery room were recorded. Values of P<0.05 were considered statistically significant.Results:There were no significant differences in age, gender, and weight between the two groups. There was no significant difference in the mean nausea scores between two groups except after 12 h postoperatively (1.39 ± 3.19 in M group vs. 0.42 ± 1.71 in M+D group). The mean vomiting frequency was significantly less in midazolam-dexamethasone group in the recovery room (0.9 ± 0.29 vs. 0 ± 0) and at 6–12 h (1.09 ± 2.41 vs. 0.3 ± 0.8), and 12–24 h (0.42 ± 1.32 vs. 0.03 ± 0.17) postoperatively. During the first 24 h postoperatively, the metoclopramid consumption was significantly less in combination therapy (6.48 ± 9.54) than in the midazolam group (12.9 ± 23.44) (Value<0.5).Conclusion:The combination of midazolam-dexametazone is more effective than midazolam alone in prevention of postoperative vomiting after middle ear surgery. Therefore, we recommend combination therapy for patients who are prone to PONV.

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Section: Discussionsupporting

confidence: 91%

“…In this study, the drugs were administrated 1 to 2 h before induction of anesthesia in patients with moderate risk of PONV. [32]…”

Section: Discussionmentioning

confidence: 99%

Comparing the preventive effect of midazolam and midazolam-dexamethasone on postoperative nausea and vomiting in elective middle ear surgery

Heidari

Yaraghi

2012

Adv Biomed Res

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“…demonstrated that the prophylactic administration of combination of midazolam and dexamethasione was superior to each drug alone in reduction of nausea and vomiting. [20] Multi disciplinary approach is advisable for prevention and therapy of PONV nowadays;[2122] and it is similar to our results.…”

Section: Discussionsupporting

confidence: 86%

Comparison of sodium diclofenac, ketamine and propofol with fentanyl and midazolam in balanced anaesthesia

et al. 2011

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Context:Analgesia is based on balanced anaesthesia, which is usually maintained by administration of narcotic agents. In some patients, it is not possible to use narcotics. We compared hemodynamic changes, anaesthesia depth, emetic sequelae and post-operative pain between sodium Diclofenac, Ketamine-Propofol (DKP) and Fentanyl-Midazolam (FM).Aims:The effectiveness of an anaesthetic technique employing sodium was compared against in patients undergoing elective surgery.Settings and Design:In a clinical trial study, 82 patients who attended for an elective surgery were randomly divided into two groups.Materials and Methods:In DKP group pre-medication included Sodium Diclofenac 1 mg/kg and Midazolam 0.02 mg/kg, whereas, in FM group they were Fentanyl 2 μg/kg and Midazolam 0.02 mg/ kg. Anaesthesia induction in both groups was the same. Anaesthesia was conserved in DKP group by using Propofol plus Ketamine infusion plus N2O 50% and in FM group with Fentanyl plus Midazolam plus N2O 50%. Hemodynamic changes, depth of anaesthesia, nausea and vomiting, post operative analgesic effects were recorded.Results:Hemodynamic changes and depth of anaesthesia were similar throughout the maintenance phase in two groups. In FM group, significant increase in heart rate was recorded in recovery room. Pain score according to visual analogue scale (VAS) and need for analgesics, was significantly more in FM group compared to DKP group (P = 0.000). No patient suffered from nausea, vomiting or hallucinations.Conclusions:This study revealed that intravenous administration of Sodium Diclofenac along with Ketamine and Propofolplus N2O 50% for general anaesthesia provides a balanced anaesthesia as well as hemodynamic stability, and adequate depth of anaesthesia. It also reduces the postoperative pain and need for narcotics. We recommended DKP plus N2O 50% method for patients prohibited from opioid administration. It will be an acceptable method in sensitive patients.

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“…25 It was reported that midazolam administered 30 min before the end of surgery was more effective in decreasing the incidence of PONV than midazolam given 15 min before induction of anaesthesia, in patients who had undergone lower abdominal surgery lasting 1-2 h. 12 In previous studies, doses of midazolam for preventing PONV were 35-75 mg/kg. 11,12,17,24 Watcha and White 21 recommended the use of minimally effective doses of antiemetic drugs to reduce the incidence of sedation and other deleterious side-effects, and potent nonopioid analgesics such as ketorolac can be used to avoid some opioid-related adverse effects. The present study used 50 mg/kg of midazolam and (as a rescue analgesic) ketorolac; the incidence of adverse events did not differ significantly among the three treatment groups.…”

Section: Adverse Eventmentioning

confidence: 99%

“…9 Midazolam is a commonly used drug for sedation, premedication and co-induction of anaesthesia. Besides its known anxiolytic effects, it has been reported that midazolam plays a role in the prevention [10][11][12][13][14] and treatment 15,16 of PONV. Midazolam administered after the induction of anaesthesia, with or without dexamethasone, reduced the incidence of PONV in children following strabismus repair.…”

Section: Introductionmentioning

confidence: 99%

Comparison of ramosetron with combined ramosetron and midazolam for preventing postoperative nausea and vomiting in patients at high risk following laparoscopic gynaecological surgery

et al. 2013

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Effect of midazolam, dexamethasone and their combination on the prevention of nausea and vomiting following strabismus repair in children

Abstract: Prophylactic midazolam with or without dexamethasone reduces the incidence of PONV in children undergoing strabismus repair.

Cited by 31 publications

References 23 publications

Comparing the preventive effect of midazolam and midazolam-dexamethasone on postoperative nausea and vomiting in elective middle ear surgery

Comparing the preventive effect of midazolam and midazolam-dexamethasone on postoperative nausea and vomiting in elective middle ear surgery

Comparison of sodium diclofenac, ketamine and propofol with fentanyl and midazolam in balanced anaesthesia

Comparison of ramosetron with combined ramosetron and midazolam for preventing postoperative nausea and vomiting in patients at high risk following laparoscopic gynaecological surgery

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