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

Abstract

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.

Effect of Adding Midazolam to Dual Prophylaxis for Preventing Postoperative Nausea and Vomiting

“…Another study reported that administering midazolam 2 mg towards the end of surgery had an antiemetic effect similar to that of dual prophylaxis with IV dexamethasone 8 mg and IV ondansetron 4 mg. The PONV incidence within 24 h was 30% for the midazolam group and 33% for the dexamethasone and ondansetron group in patients undergoing laparoscopy, with an Apfel score ≥2, which was similar to the findings of our study [ 28 ]. Midazolam was also effective when used as a combination therapy with other classes of antiemetics.…”

“…Therefore, the antiemetic effect of midazolam may result from the activation of different receptors when compared with other antiemetics such as ondansetron or dexamethasone. As in the aforementioned studies, the frequently used midazolam doses for PONV were 2 mg or 0.04–0.075 mg/kg [ 12 , 13 , 26 , 27 , 28 ]. Grant et al [ 10 ] showed similar effects between lower (<0.05 mg/kg) and higher doses (≥0.075 mg/kg) for preventing PONV, and we decided to use midazolam 0.05 mg/kg.…”

Comparison of postoperative nausea and vomiting between Remimazolam and Propofol in Patients undergoing oral and maxillofacial surgery: a prospective Randomized Controlled Trial

“…Prakash et al [ 16 ] reported that midazolam may reduce the incidence of PONV by inhibiting the chemoreceptor trigger zone activity and reducing the release of 5-hydroxy tryptamine (5-HT) by binding to the gamma-aminobutyric acid (GABA) receptor. However, since remimazolam is rapidly metabolized by carboxylesterase, the context-sensitive half-time (CSHT) is 7–8 min for a 2-hour continuous infusion, which is similar to that of propofol and much shorter than that of midazolam [ 17 ].…”