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Comparative study of the antiemetic efficacy of ondansetron, propofol and midazolam in the early postoperative period

Published online by Cambridge University Press:  23 December 2004

H. Unlugenc ,
T. Guler ,
Y. Gunes  and
G. Isik
H. Unlugenc
Affiliation:
Cukurova University, Faculty of Medicine, Department of Anaesthesiology, Adana, Turkey
T. Guler
Affiliation:
Cukurova University, Faculty of Medicine, Department of Anaesthesiology, Adana, Turkey
Y. Gunes
Affiliation:
Cukurova University, Faculty of Medicine, Department of Anaesthesiology, Adana, Turkey
G. Isik
Affiliation:
Cukurova University, Faculty of Medicine, Department of Anaesthesiology, Adana, Turkey
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Extract

Summary

Background and objective: To compare the antiemetic efficacy of ondansetron with two different hypnotic drugs (propofol 15 mg, midazolam 1 and 2 mg) for the treatment of established postoperative nausea and vomiting (PONV).

Methods: Four-hundred-and-fifty-three patients scheduled for elective gynaecological or abdominal surgery were enrolled. One-hundred-and-twenty patients (26%) experienced postoperative emesis, and when nausea scores reached 2 or greater on a five-point scale, they were randomized to receive intravenously: propofol 15 mg (1.5 mL) in Group P, midazolam 1 mg in Group M1, midazolam 2 mg in Group M2 and ondansetron 4 mg in Group O.

Results: Four patients (13.3%) in Group P, 13 patients (43.3%) in Group M1, five patients (16.6%) in Group M2 and one patient (3.3%) in Group O required a second dose of the study drug. After administration of the study drugs, nausea scores were significantly lower in all groups than before these drugs were given. No patient had a sedation score over 3 (the patients remained awake and/or responded to verbal contact). The sedative effects of midazolam and propofol lasted for a much shorter time than the antiemetic effects of these drugs.

Conclusions: Propofol and midazolam used in subhypnotic doses were as effective as ondansetron in treating PONV in patients undergoing abdominal or gynaecological surgery without untoward sedative or cardiovascular effects.

Keywords

ANAESTHETICS, INTRAVENOUS, propofolANTIEMETICS, ondansetronBENZODIAZEPINES, midazolamPOSTOPERATIVE COMPLICATIONS, postoperative nausea and vomiting
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 21 , Issue 1 , January 2004 , pp. 60 - 65
Copyright
2004 European Society of Anaesthesiology

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References

Camu F, Lauwers MH, Verbessem D. Incidence and aetiology of postoperative nausea and vomiting. Eur J Anaesthesiol 1992; 9: 25–31.Google Scholar
Andersen R, Krogh K. Pain as a major cause for postoperative nausea. Can Anaesth Soc J 1976; 23: 366–369.Google Scholar
Borgeat A, Wilder-Smith OHG, Suter PM. The non-hypnotic therapeutic applications of propofol. Anesthesiology 1994; 80: 642–656.Google Scholar
Splinter WM, Rhine EJ, Roberts DJ. Vomiting after strabismus surgery in children: ondansetron vs propofol. Can J Anaesth 1997; 44: 825–829.Google Scholar
Di Florio T. Is propofol a dopamine antagonist? Anesth Analg 1993; 77: 200–201.Google Scholar
Splinter WM, MacNeill HB, Menard EA, Rhine EJ, Roberts DJ, Gould MH. Midazolam reduces vomiting after tonsillectomy in children. Can J Anaesth 1995; 42: 201–203.Google Scholar
Borgeat A, Wilder-Smith OHG, Saiah M, Rifat K. Subhypnotic doses of propofol possess direct antiemetic properties. Anesth Analg 1992; 74: 539–541.Google Scholar
Song D, Whitten CW, White PF, Yu SY, Zarate E. Antiemetic activity of propofol after sevoflurane and desflurane anesthesia for outpatient laparoscopic cholecystectomy. Anesthesiology 1999; 90: 1789–1790.Google Scholar
Splinter W, Noel LP, Roberts D, Rhine E, Bonn G, Clarke W. Antiemetic prophylaxis for strabismus surgery. Can J Ophthalmol 1994; 29: 224–226.Google Scholar
Cole WH. Midazolam in paediatric anaesthesia. Anaesth Intensive Care 1982; 10: 36–39.Google Scholar
Blackwell CP, Harding SM. Clinical pharmacology of ondansetron. Eur J Cancer Clin Oncol 1989; 25: 21–27.Google Scholar
Chernik DA, Gillings D, Laine H, et al. Validity and reliability of the Observer's Assessment of Alertness/Sedation (OAA/S) scale: study with intravenous midazolam. J Clin Psychopharmacol 1990; 10: 244–251.Google Scholar
Madej TH, Simpson KH. Comparison of the use of domperidone, droperidol and metoclopramide in the prevention of nausea and vomiting following gynaecological surgery in day cases. Br J Anaesth 1986; 58: 884–887.Google Scholar
Ewalenko P, Janny S, Dejonckheere M, Andry G, Wyns C. Antiemetic effect of subhypnotic doses of propofol after thyroidectomy. Br J Anaesth 1996; 77: 463–467.Google Scholar
Appadu BL, Strange PG, Lambert DG. Does propofol interact with D2 dopamine receptor? Anesth Analg 1994; 79: 1191–1192.Google Scholar
Gan TJ, El-Molem H, Ray J, Glass PSA. Patient-controlled antiemesis. A randomized, double blind comparison of two doses of propofol versus placebo. Anesthesiology 1999; 90: 1564–1570.Google Scholar
Harper I, Della-Marta E, Owen H, Plummer J, Ilsley A. Lack of efficacy of propofol in the treatment of early postoperative nausea and vomiting. Anaesth Intensive Care 1998; 26: 366–370.Google Scholar
Di Florio T, Goucke CR. The effect of midazolam on persistent postoperative nausea and vomiting. Anaesth Intensive Care 1999; 27: 38–40.Google Scholar
Kay NH, Sear JW, Uppington J, Cockshott ID, Douglas EJ. Disposition of propofol in patients undergoing surgery: A comparison in men and women. Br J Anaesth 1986; 58: 1075–1079.Google Scholar
Larijani GE, Gratz I, Afshar M, Minassian S. Treatment of postoperative nausea and vomiting with ondansetron: a randomized, double-blind comparison with placebo. Anesth Analg 1992; 74: 473–474.Google Scholar
Polati E, Verlato G, Finco G, et al. Ondansetron versus metoclopramide in the treatment of postoperative nausea and vomiting. Anesth Analg 1997; 85: 395–399.Google Scholar
Tramèr MR, Reynolds DJM, Moore RA, McQuay HJ. Efficacy, dose–response, and safety of ondansetron in prevention of postoperative nausea and vomiting: a quantitative systematic review of randomized placebo-controlled trials. Anesthesiology 1997; 87: 1277–1289.Google Scholar
Tramèr MR, Reynolds DJM, Stoner NS, Moore RA, McQuay HJ. Efficacy of 5-HT3 receptor antagonists in radiotherapy-induced nausea and vomiting: a quantitative systematic review. Eur J Cancer 1998; 34: 1836–1844.Google Scholar