SummaryThis prospective, double-blind study examined the antiemetic effectiveness of the addition of droperidol to a morphine solution for use in patient-controlled analgesia in a group of 50 patients undergoing elective lumbar laminectomy. The addition of 20mg droperidol to 120 mg morphine in 60 ml saline given by a Baxter 'Infusor' patient-controlled analgesia device reduced the incidence of vomiting as compared to the addition of sodium chloride from 42.8% to 12.5% (p = 0.028) and of nausea from 71.4% to 29.2% (p = 0.005). The proportion of patients requiring rescue antiemetic therapy was reduced from 47.6% to 16.7% (p = 0.025) and the time interval to thejirst use of rescue antiemetic agent was significantly prolonged (p = 0.029). The use of droperidol was associated with an increased degree of sedation during thejirst 12 h after operation. Key wordsPain; postoperative. Vomiting; antiemetics, droperidol.Patient-controlled analgesia (PCA) is an effective and increasingly popular method of providing postoperative analgesia, with advantages for the patient and for medical and nursing staff. However, nausea is reported to be a relatively common side effect, its incidence being similar to that seen with conventional intramuscular analgesia [I].When prescribing postoperative analgesia, it is common clinical practice to prescribe, in addition, antiemetic drugs as required, usually given intramuscularly or orally. However, there are potential drawbacks to both of these routes: intramuscular injections are painful and there is often an inevitable delay between need and administration, whilst oral antiemetics may not be absorbed and hence ineffective. It would therefore seem preferable to utilise the intravenous route which will exist if PCA is being employed. The use of antiemetic agents given with opioid analgesia might also have a prophylactic antiemetic effect. Droperidol has been shown to be an effective antiemetic agent in a number of clinical situations [2-4]. The present study was designed to assess the effectiveness of droperidol, given in conjunction with morphine PCA in reducing postoperative nausea and vomiting. MethodThis double-blind, randomised, prospective, placebocontrolled study was approved by the hospital ethics committee. Patients presenting for lumbar laminectomy were approached by the investigators to assess their suitability and consent for inclusion in the study. Patients who were pregnant, had a hiatus hernia or a clinical history that would suggest a significant risk of acid reflux were not studied. Any history of motion sickness or previous postoperative nausea and vomiting was noted. Patients giving informed consent were instructed in the use of a Baxter 'Infusor' PCA device and educated in the use of the pain and nausea scoring scales. A 10-point pain scale and a 5-point nausea scale were used in this study (Fig. 1). These scales were chosen because they were routinely in use on the neurosurgical wards and were therefore familiar to the nursing staff. The nursing staff were also instructe...
SummaryAn oesophageal p H electrode was used to record gastro-oesophageal rejux in 73 women who had elective Iaparoscopy for various gynaecological procedures. No refluxes were recorded during the 63 procedures from which results could be analysed; the upper 95% conjidence limit from this observation is 3 in 63 (4.8%). Two of the excluded women rejuxed during episodes of hiccough that occurred shortly after induction of anaesthesia. Tracheal intubation may be required during laparoscopy, although the need to protect against the possibility of aspiration of gastric contents may not be a valid reason unless, with the same logic, it is suggested that all patients who hiccough should be intubated Key wordsComplications; aspiration. Surgery; laparoscopy.It is commonly thought that laparoscopy increases the likelihood of regurgitation of gastric contents. Reasons given include the lithotomy position, head-down tilt, the surgeon pressing on the abdomen and insufflation of the peritoneal cavity. Duffy' measured the pharyngeal pH at the end of the procedure; in two of 93 patients who had undergone elective laparoscopy the pharyngeal contents were acid. Carlsson and Islander2 used a similar technique and showed that regurgitation occurred in 20% of emergency laparoscopies.A continuous intra-operative recording of oesophageal pH in the present study was made with an antimony pH electrode placed in the distal oesophagus during elective laparoscopies. MethodsThe study was approved by the hospital ethics committee. Seventy-five consecutive women who required anaesthesia for elective laparoscopy were approached for the study and all but two gave informed consent.The patients were ASA 1 or 2, aged 18 to 62 years, and weighed between 45 and 86 kg. The ratio of weight to the square of height was used as a measure of obesity: the mean (range) was 23.7 (18.3 to 33.7) kg/sq m (mild obesity is 30 kg/sq m). Four patients gave a history of occasional reflux after meals. All patients were fasted by mouth for at least 8 hours, except that temazepam 20 mg was offered as premedication and accepted by 12 patients.Anaesthesia was induced with propofol (2.5 mg/kg) and fentanyl (2.3 pg/kg) and vecuronium (0.08 mg/kg) was given to provide muscular relaxation. The patients' lungs were ventilated by hand with 67% nitrous oxide in oxygen, with 1% isoflurane or enflurane, before laryngoscopy and intubation of the trachea. Anaesthesia was maintained with inhalational agents delivered by mechanical ventilation.Oesophageal pH was measured with a monocrystalline antimony pH electrode (Synectics Medical Ltd) calibrated before each set of measurements with standardised solutions of buffer at pH 1 and 7. The electrode is enclosed in the tip of a 2-mm soft plastic tube, which was inserted under direct vision at laryngoscopy and advanced until gastric pH was recorded. It was then withdrawn to the gastro-oesophageal junction, recognised by an abrupt increase in pH, and finally positioned 4 to 5 cm above the junction. Any subsequent decrease in the measured p...
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