Dexamethasone alone versus in combination with intra-operative super-hydration for postoperative nausea and vomiting prophylaxis in female patients undergoing laparoscopic cholecystectomy: a randomized clinical trial

Abstract

BackgroundDexamethasone has a prophylactic effect on postoperative nausea and vomiting (PONV) and perioperative hydration is believed to play a role in PONV prophylaxis. This study was performed to examine the combined effects of pre-induction dexamethasone plus super-hydration on PONV and pain following laparoscopic cholecystectomy (LC).MethodsA total of 100 female patients undergoing LC were enrolled and randomized equally into two groups. Group DF received 5 mg dexamethasone (pre-induction) plus 30 ml/kg Ringer's lactate (intraoperative) and group D received 5 mg dexamethasone (pre-induction) alone. Anesthetic and surgical managements were standardized for all patients. The incidence and severity of PONV, and intra and post-operative analgesic and postoperative antiemetic consumption, were assessed during the first 24 h postoperatively. Post-anesthesia care unit (PACU) stay and aggregated 24 h pain scores were calculated.ResultsGroup DF had significantly lower PONV than group D (P = 0.03). The number of patients with the lowest PONV score was significantly increased in group DF (P = 0.03). Ondansetron consumption was significantly lower in group DF (P < 0.0001). The mean accumulated 24 h pain scores were significantly lower in group DF compared to group D (P < 0.0001). The time to first analgesic request was significantly longer in group DF than group D (P < 0.0001). In addition, total meperidine consumption during the first postoperative 24 h was significantly lower in group DF than group D (P = 0.002).ConclusionsIn female patients undergoing LC, pre-induction with 5 mg dexamethasone plus intraoperative 30 ml/kg Ringer's lactate solution decreased PONV and pain during the first 24 h postoperatively compared to 5 mg dexamethasone alone.

Pengaruh Pemberian Minuman Karbohidrat (Maltodekstrin 12,5%) Praoperasi terhadap Kejadian Mual dan Muntah Pascamastektomi

“…Pemberian CHO praoperasi dapat menurunkan resistensi insulin dikarenakan masih terdapat glukosa di dalam sirkulasi selama masa operasi sehingga emetik sehingga terjadi PONV. 1,9,10,13 Pada penelitian ini didapatkan efek CHO dalam menurunkan kejadian PONV signifikan dalam 0-120 menit dan tidak signifikan pada 2-24 jam pascaoperasi. Hal ini tidak sesuai dengan penelitian sebelumnya yang dilakukan pada 40 pasien yang menjalani operasi laparoskopik kolesistektomi yang menunjukkan pemberian CHO mengurangi PONV hingga 24 jam pascaoperasi.…”

“…Jika iskemia ini tidak dikoreksi akan menyebabkan pelepasan serotonin berlebihan yang dapat mencetuskan PONV. 9,10 Beberapa penelitian sudah dilaksanakan sebelumnya, penelitian yang dilakukan di India pada pasien yang menjalani prosedur laparoskopi menyatakan penurunan kejadian PONV yang signifikan pada pasien yang diberikan terapi CHO praoperasi dibanding dengan pasien yang tidak diberikan CHO sebesar 38-60%. 1 Tujuan penelitian ini adalah mengetahui pengaruh pemberian minuman karbohidrat praoperasi terhadap kejadian mual dan muntah pascamastektomi.…”

Supplemental peri‐operative intravenous crystalloids for postoperative nausea and vomiting: an abridged Cochrane systematic review

“…In a minority of studies, comparator groups were administered an i.v. supplemental crystalloid bolus comparable to this volume[25,29,32,35,37,40,41,45,53,54,58].Figure 2shows the risk of bias for each study. This was generally low to moderate across all included studies, but eight studies were at high risk of bias[20,21,42,43,47,48,56,59].…”

“…One study (30 participants) used a dextrose-containing solution in the intervention group[52], and a sensitivity analysis found that inclusion of this study did not substantially affect the risk ratio or the statistical heterogeneity. Additional planned sensitivity analyses of studies at low risk of bias[23,24,29,36,41,46,49], and of studies administering comparator groups at least 10 ml.kg -1 of supplemental i.v.crystalloid[29,32,41,45,54] also did not substantially affect the risk ratio.…”

Should ondansetron be used as a routine prophylaxis agent for postoperative nausea and vomiting?

“…We read with great interest the article of Ismail et al [ 1 ] in a recent issue of the Journal. The authors performed a randomized controlled trial in 100 female patients who underwent laparoscopic cholecystectomy.…”