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

Park, Eun Young; Lee, Soo Kyung; Kang, Myung-Soo; Lim, Kyung Jee; Kim, Yi Seul; Choi, Eun Young; Park, Young-Han

doi:10.1177/0300060513487627

Cited by 16 publications

(14 citation statements)

References 30 publications

(61 reference statements)

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“…It indicated that 40 patients per group were required [25]. Assuming a potential dropout rate of 10%, the final sample size was set at 44 patients per group.…”

Section: Methodsmentioning

confidence: 99%

Combination of gabapentin and ramosetron for the prevention of postoperative nausea and vomiting after gynecologic laparoscopic surgery: a prospective randomized comparative study

et al. 2017

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BackgroundAs a drug originally introduced for its anticonvulsant effects, gabapentin has been recently shown to be effective in the treatment of nausea and vomiting in various clinical settings. This study compared the antiemetic efficacy of oral gabapentin, intravenous ramosetron and gabapentin plus ramosetron in patients receiving fentanyl-based patient-controlled analgesia after laparoscopic gynecologic surgery.MethodsOne hundred and thirty two patients undergoing laparoscopic gynecologic surgery under general anesthesia were allocated randomly into three groups: group G received 300 mg oral gabapentin 1 h before anesthesia, group R received 0.3 mg intravenous ramosetron at the end of surgery, and group GR received a combination of 300 mg oral gabapentin 1 h before anesthesia and 0.3 mg intravenous ramosetron at the end of surgery. Postoperative nausea, retching, vomiting, rescue antiemetic drug use, pain, rescue analgesic requirements and adverse effects were assessed at 0–2, 2–24 and 24–48 h after surgery. Postoperative nausea and vomiting (PONV) was defined as the presence of nausea, retching or vomiting.ResultsThe incidence of complete response (no PONV and no rescue antiemetics up to 48 h postoperatively) was significantly higher in group GR (26/40, 65%) than group G (16/40, 40%; P = 0.025) and group R (18/44, 41%; P = 0.027), whereas there was no significant difference between group G and group R (P = 0.932). There were no significant between-group differences in the incidence of emetic episodes, use of rescue antiemetics, severe emesis, use of rescue analgesics or any adverse effects. Postoperative pain scores were also similar among groups.ConclusionsThe combination with gabapentin and ramosetron is superior to either drug alone for prevention of PONV after laparoscopic gynecologic surgery.Trial registrationClinicalTrials.gov NCT02617121, registered November 25, 2015.

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“…It indicated that 40 patients per group were required [25]. Assuming a potential dropout rate of 10%, the final sample size was set at 44 patients per group.…”

Section: Methodsmentioning

confidence: 99%

Combination of gabapentin and ramosetron for the prevention of postoperative nausea and vomiting after gynecologic laparoscopic surgery: a prospective randomized comparative study

et al. 2017

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“…5 Similarly, Park and colleagues, in their study on 126 patients undergoing laparoscopic gynaecological surgeries, reported that incidence of complete response was around 70% with a combination of midazolam and ramosetron while it was 44% with ramosetron alone. 18 A few studies have examined the role of midazolam and dexamethasone in reducing PONV. 7,19 In children undergoing strabismus surgeries under general anaesthesia, Raid et al found that no child vomited when midazolam was used alone or in combination with dexamethasone as compared to 32% with dexamethasone alone.…”

Section: Ta B L Ementioning

confidence: 99%

Midazolam versus dexamethasone‐ondansetron in preventing post‐operative nausea‐vomiting in patients undergoing laparoscopic surgeries

Prakash

Meshram

Jain

2021

Acta Anaesthesiol Scand

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Background: Midazolam reduces post-operative nausea and vomiting (PONV) when compared to a placebo or when used as an adjuvant to other antiemetics. The present study was designed to compare midazolam with a combination of dexamethasoneondansetron in preventing PONV.Methods: One hundred and twenty patients undergoing laparoscopic surgeries having 2 or more risk factors for PONV (simplified Apfel score) were randomised into 2 groups of 60 each. Patients in group D received 8-mg dexamethasone and 4-mg ondansetron for PONV prophylaxis while those in group M received 2-mg midazolam towards the end of surgery. The proportion of patients (frequency) who had PONV, post-operative nausea (PON) and post-operative vomiting (POV) was noted over 24 hours over the following intervals: 0-2 hours, 2-24 hours and 0-24 hours. Results:The frequency of PONV at 24 hours in group D and group M was 30% and 33.3% respectively and was not significantly different (P = .70). There was no difference in the time to achieve post-anaesthesia discharge score of ≥9 between the two groups {5 minutes (5, 5) in group D; 5 minutes (1.25, 5) in group M, P = .48}. Ten patients in group D and 11 in group M required a rescue antiemetic over 24 hours (P = .81). The frequency of PON, POV and PONV as well as the median PONV score was similar at all time periods. Conclusion:Midazolam does not result in significantly different frequency of PONV than a combination of dexamethasone-ondansetron. Editorial CommentThe antiemetic properties of midazolam are not always recognised. This RCT allocated 120 patients with 2 or more PONV risk factors undergoing laparoscopic surgery to prophylaxis with either 2-mg midazolam or a combination of 8-mg dexamethasone and 4-mg ondansetron. Follow-up within 24 hours found similar frequency of PONV at all time points. While this small trial was not designed as an equivalence or non-superiority trial, there may be reason to conduct a larger non-inferiority study of this question. | 871 PRAKASH et Al.

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“…The postulated antiemetic mechanism of midazolam includes glycine mimetic inhibitory effects, adenosinergic effects, and inhibition of dopamine release [21]. Midazolam may also affect striatal dopamine release, and the anesthetic actions of midazolam are partially related to inhibition of dopamine neuron A1 activity [22].…”

Section: Discussionmentioning

confidence: 99%

Prophylactic Midazolam For Prevention Of Post-Operative Nausea And Vomiting Following Adenoidectomy or Adenotonsillectomy

Özcan

Çanakçı

et al. 2017

Ortadogu Tıp Derg

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Aim: Postoperative nausea and vomiting (PONV) is a common complication after tonsillectomy. Midazolam is known to decrease postsurgical vomiting. In this study, we investigate the effect of intramuscular Midazolam on postoperative nausea vomiting in children undergoing adenoidectomy or adenotonsillectomy. Material and Method: In a randomized double-blind study, we evaluated 66 healthy children, aged 5-12 years, who underwent adenoidectomy with or without tonsillectomy. Afterwards, anesthesia was induced by inhalation of sevoflurane, rocuronium bromide 0.6 mg kg-1, and fentanyl 1 µg kg-1, and anesthesia was maintained by sevoflurane for all patients. Patients were administered subcutaneous morphine 0.1 mg kg-1 for postoperative analgesia. Patient's in-Group II were administered intramuscular midazolam 0.1 mg kg-1. The incidence of nausea/vomiting and antiemetic requirement 0-4 h and 4-24 h post surgery was recorded. Data for postoperative vomiting were grouped into the following time periods: 0-4 and 4-24 h. Data were analyzed using a Student's t-test and chi-squared analysis. Results: No statistically significant different was found between groups in 0-4, and 4-24 hours in terms of median VAS levels (p=0,883 and p=0,881). Although Group II had lower incidence of nausea both in 0-4 and 4-24 hours compared to Group I, there was no statistically significant difference between the groups (p=0,618 and p=0,28). There was no statistically significant difference between the groups in 0-4, and 4-24 hours in terms of median nausea VAS levels (p=0,597 and p=0,982). There was also no statistically significant difference between the groups in terms of rates of additional analgesic requirement in 24 hours, and median additional analgesic number (p=0,197 and p=0,865). Antiemetic requirement rates in 24 hours in Group II were lower at a statistically significant rate compared to Group I (p=0,027). Yet, there was no statistically significant difference between the groups in terms of median antiemetic number in 24 hours (p=0,070). Conclusion: For children undergoing tonsillectomy, intraoperative midazolam treatment does not provide a prophylaxis against postoperative vomiting.

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

Abstract: Midazolam given at induction of anaesthesia or at the end of the surgery, combined with ramosetron, was more effective than ramosetron alone in reducing the incidence of PONV.

Cited by 16 publications

References 30 publications

Combination of gabapentin and ramosetron for the prevention of postoperative nausea and vomiting after gynecologic laparoscopic surgery: a prospective randomized comparative study

Combination of gabapentin and ramosetron for the prevention of postoperative nausea and vomiting after gynecologic laparoscopic surgery: a prospective randomized comparative study

Midazolam versus dexamethasone‐ondansetron in preventing post‐operative nausea‐vomiting in patients undergoing laparoscopic surgeries

Prophylactic Midazolam For Prevention Of Post-Operative Nausea And Vomiting Following Adenoidectomy or Adenotonsillectomy

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