Comparative Study of the Preemptive Dexmedetomidine Versus Ondansetron Effect in Post-Operative Nausea and Vomiting after Middle Ear Surgery
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Abstract
Background: Nausea and vomiting after operation has high prevalence and cause adverse effect. The aim of this study was to compare the effect of dexmedetomidine with ondansetron in prevention of post-operative nausea and vomiting (PONV) after middle ear surgery under general anesthesia.and saliva gas in traumatic patients under mechanical ventilation.
Methods: This in this double-blinded clinical trial study, one hundred and sixty-two patients undergoing middle ear surgery under general anesthesia were randomly divided into three groups of 55 each: ondansetron (O), dexmedetomidine (D) and control (C). Group O received 0.1 mg/kg of ondansetron, Group D received 1 μg/kg/min of dexmedetomidine and Group C received 10 cc of normal saline 15 to 20 minutes before surgical incision. After that, the patients were examined in post-anesthesia care unit (PACU) and up to 24 hours after the operation in terms of PONV and other study variables.
Results: The severity of nausea after operation based on VAS (visual analog scale) was significantly different between Group O (2.2±0.7) and Group D (3.9± 0.7) and Group C (5.15±1.3) (P= 0.04). The incidence of vomiting in the first 24h postoperatively was 14.8% in Group O, 46.3% in Group D and 88.8% in Group C (P= 0.003).
Conclusion: Our study showed that ondansetron was better than dexmedetomidine for prevention of PONV after middle ear surgery.
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[10] Awad K, Ahmed H, Abushouk AI, Al Nahrawi S, Elsherbeny MY, Mustafa SM, et al. Dexamethasone combined with other antiemetics versus single antiemetics for prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy: An updated systematic review and meta-analysis. Int J Surg. 2016; 36(Pt A):152-163.
[11] Ghosh S, Rai KK, Shivakumar HR, Upasi AP, Naik VG, Bharat A. Incidence and risk factors for postoperative nausea and vomiting in orthognathic surgery: a 10-year retrospective study. J Korean Assoc Oral Maxillofac Surg. 2020;46(2):116-124.
[12] Adriani J, Summers FW, Antony SO. Is the prophylactic use of antiemetics in surgical patients justified? JAMA. 1961; 175:666–71.
[13] Roberts GW, Bekker TB, Carlsen HH, Moffatt CH, Slattery PJ, McClure AF. Postoperative nausea and vomiting are strongly influenced by postoperative opioid use in a dose-related manner. Anesth Analg. 2005; 101(5):1343–8.
[14] Apfel CC, Philip BK, Cakmakkaya OS, Shilling A, Shi Y-Y, Leslie JB, et al. Who is at risk for postdischarge nausea and vomiting after ambulatory surgery? Anesthesiology. 2012; 117(3):475–86.
[15] Samieirad S, Sharifian-Attar A, Eshghpour M, Mianbandi V, Shadkam E, Hosseini-Abrishami M, et al. Comparison of Ondansetron versus Clonidine efficacy for prevention of postoperative pain, nausea and vomiting after orthognathic surgeries: A triple blind randomized controlled trial. Med Oral Patol Oral Cir Bucal. 2018; 23(6): e767–76.
[16] Jeyabalan S, Thampi SM, Karuppusami R, Samuel K. Comparing the efficacy of aprepitant and ondansetron for the prevention of postoperative nausea and vomiting (PONV): A double blinded, randomised control trial in patients undergoing breast and thyroid surgeries. Indian J Anaesth. 2019; 63(4):289–94.
[17] Kamali A, Ahmadi L, Shokrpour M, Pazuki S. Investigation of Ondansetron, Haloperidol, and Dexmedetomidine Efficacy for Prevention of Postoperative Nausea and Vomiting In Patients with Abdominal Hysterectomy. Open Access Maced J Med Sci. 2018; 6(9):1659–63.
[18] Honkavaara P. Effect of ondansetron on nausea and vomiting after middle ear surgery during general anaesthesia. Br J Anaesth. 1996; 76(2):316-8.
[19] Jin S, Liang DD, Chen C, Zhang M, Wang J. Dexmedetomidine prevent postoperative nausea and vomiting on patients during general anesthesia: A PRISMA-compliant meta analysis of randomized controlled trials. Medicine (Baltimore). 2017; 96(1): e5770.
[20] Ahsan K, Abbas N, Naqvi SMN, Murtaza G, Tariq S. Comparison of efficacy of ondansetron and dexamethasone combination and ondansetron alone in preventing postoperative nausea and vomiting after laparoscopic cholecystectomy. J Pak Med Assoc. 2014; 64(3):242–6.
[21] Scuderi P, Wetchler B, Sung YF, Mingus M, DuPen S, Claybon L, et al. Treatment of postoperative nausea and vomiting after outpatient surgery with the 5-HT3 antagonist ondansetron. Anesthesiology. 1993; 78(1):15-20.
[22] Afonso J, Reis F. Dexmedetomidine: current role in anesthesia and intensive care. Rev Bras Anestesiol. 2012; 62:118–33.
[23] Massad IM, Mohsen WA, Basha AS, Al-Zaben KR, Al-Mustafa MM, Alghanem SM. A balanced anesthesia with dexmedetomidine decreases postoperative nausea and vomiting after laparoscopic surgery. Saudi Med J. 2009; 30(12):1537-41.
[2] Naemi AR, Kashanitabar V, Kamali A, Shiva A. Comparison of the Effects of Haloperidol, Metoclopramide, Dexmedetomidine and Ginger on Postoperative Nausea and Vomiting After Laparoscopic Cholecystectomy. J Med Life. 2020; 13(2):206–10.
[3] Liu HM, Chen JH, Chen C, Liou CM. Prophylactic antiemetic effects of dexamethasone versus 5-HT3 receptor antagonists in ear surgery: a systematic review and meta-analysis. Int J Clin Pharm. 2021; 43(3):476-485.
[4] Bakan M, Umutoglu T, Topuz U, Uysal H, Bayram M, Kadioglu H, et al. Opioid-free total intravenous anesthesia with propofol, dexmedetomidine and lidocaine infusions for laparoscopic cholecystectomy: a prospective, randomized, double-blinded study. Braz J Anesthesiol. 2015; 65(3):191–9.
[5] Tan HS, Habib AS. The optimum management of nausea and vomiting during and after cesarean delivery. Best Pract Res Clin Anaesthesiol. 2020;34(4):735-747.
[6] Shaikh SI, Nagarekha D, Hegade G, Marutheesh M. Postoperative nausea and vomiting: A simple yet complex problem. Anesth Essays Res. 2016; 10(3):388–96.
[7] Gan TJ, Belani KG, Bergese S, Chung F, Diemunsch P, Habib AS, et al. Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting. Anesth Analg. 2020; 131(2):411–48.
[8] Chatterjee S, Rudra A, Sengupta S. Current concepts in the management of postoperative nausea and vomiting. Anesthesiol Res Pract. 2011; 2011:748031.
[9] Kocaturk O, Keles S, Omurlu IK. Risk factors for postoperative nausea and vomiting in pediatric patients undergoing ambulatory dental treatment. Niger J Clin Pract. 2018; 21(5):597-602.
[10] Awad K, Ahmed H, Abushouk AI, Al Nahrawi S, Elsherbeny MY, Mustafa SM, et al. Dexamethasone combined with other antiemetics versus single antiemetics for prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy: An updated systematic review and meta-analysis. Int J Surg. 2016; 36(Pt A):152-163.
[11] Ghosh S, Rai KK, Shivakumar HR, Upasi AP, Naik VG, Bharat A. Incidence and risk factors for postoperative nausea and vomiting in orthognathic surgery: a 10-year retrospective study. J Korean Assoc Oral Maxillofac Surg. 2020;46(2):116-124.
[12] Adriani J, Summers FW, Antony SO. Is the prophylactic use of antiemetics in surgical patients justified? JAMA. 1961; 175:666–71.
[13] Roberts GW, Bekker TB, Carlsen HH, Moffatt CH, Slattery PJ, McClure AF. Postoperative nausea and vomiting are strongly influenced by postoperative opioid use in a dose-related manner. Anesth Analg. 2005; 101(5):1343–8.
[14] Apfel CC, Philip BK, Cakmakkaya OS, Shilling A, Shi Y-Y, Leslie JB, et al. Who is at risk for postdischarge nausea and vomiting after ambulatory surgery? Anesthesiology. 2012; 117(3):475–86.
[15] Samieirad S, Sharifian-Attar A, Eshghpour M, Mianbandi V, Shadkam E, Hosseini-Abrishami M, et al. Comparison of Ondansetron versus Clonidine efficacy for prevention of postoperative pain, nausea and vomiting after orthognathic surgeries: A triple blind randomized controlled trial. Med Oral Patol Oral Cir Bucal. 2018; 23(6): e767–76.
[16] Jeyabalan S, Thampi SM, Karuppusami R, Samuel K. Comparing the efficacy of aprepitant and ondansetron for the prevention of postoperative nausea and vomiting (PONV): A double blinded, randomised control trial in patients undergoing breast and thyroid surgeries. Indian J Anaesth. 2019; 63(4):289–94.
[17] Kamali A, Ahmadi L, Shokrpour M, Pazuki S. Investigation of Ondansetron, Haloperidol, and Dexmedetomidine Efficacy for Prevention of Postoperative Nausea and Vomiting In Patients with Abdominal Hysterectomy. Open Access Maced J Med Sci. 2018; 6(9):1659–63.
[18] Honkavaara P. Effect of ondansetron on nausea and vomiting after middle ear surgery during general anaesthesia. Br J Anaesth. 1996; 76(2):316-8.
[19] Jin S, Liang DD, Chen C, Zhang M, Wang J. Dexmedetomidine prevent postoperative nausea and vomiting on patients during general anesthesia: A PRISMA-compliant meta analysis of randomized controlled trials. Medicine (Baltimore). 2017; 96(1): e5770.
[20] Ahsan K, Abbas N, Naqvi SMN, Murtaza G, Tariq S. Comparison of efficacy of ondansetron and dexamethasone combination and ondansetron alone in preventing postoperative nausea and vomiting after laparoscopic cholecystectomy. J Pak Med Assoc. 2014; 64(3):242–6.
[21] Scuderi P, Wetchler B, Sung YF, Mingus M, DuPen S, Claybon L, et al. Treatment of postoperative nausea and vomiting after outpatient surgery with the 5-HT3 antagonist ondansetron. Anesthesiology. 1993; 78(1):15-20.
[22] Afonso J, Reis F. Dexmedetomidine: current role in anesthesia and intensive care. Rev Bras Anestesiol. 2012; 62:118–33.
[23] Massad IM, Mohsen WA, Basha AS, Al-Zaben KR, Al-Mustafa MM, Alghanem SM. A balanced anesthesia with dexmedetomidine decreases postoperative nausea and vomiting after laparoscopic surgery. Saudi Med J. 2009; 30(12):1537-41.
| Files | ||
| Issue | Vol 10 No 3 (2024): Summer |
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| Section | Research Article(s) | |
| DOI | https://doi.org/10.18502/aacc.v10i3.15689 | |
| Keywords | ||
| Ondansetron Dexmedetomidine Post-operative nausea and vomiting middle ear surgery | ||
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How to Cite
1.
Safavi M, Honarmand A, Nazemroaya B, Maleky N. Comparative Study of the Preemptive Dexmedetomidine Versus Ondansetron Effect in Post-Operative Nausea and Vomiting after Middle Ear Surgery. Arch Anesth & Crit Care. 2023;10(3):221-226.
