Premium
Effect of Sevoflurane plus Ondansetron and Ranitidine vs. Propofol and Remifentanil for the Prevention of Post‐operative Nausea and Vomiting
Author(s) -
Lynch Sharlette M,
Tulp Orien L,
Einstein George P
Publication year - 2017
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.31.1_supplement.675.7
Subject(s) - remifentanil , medicine , anesthesia , ondansetron , propofol , postoperative nausea and vomiting , sevoflurane , vomiting , nausea , mean arterial pressure , blood pressure , heart rate
Postoperative nausea and vomiting (PONV) are frequent and distressing complications following anesthesia [AN] and general surgery [GS]. The purpose of this study was to compare total intravenous AN (TIVA) using propofol and remifentanil [TIVA‐PR] vs. sevoflurane with prophylactic ondansetron and ranitidine [TIVA‐SF group] for the prevention of PONV. Hemodynamic changes [heart rate [HR] blood pressure [BP], and the quality of recovery such as post‐operative pain [POP] were compared between the two groups. Patients [n=60] undergoing AN and GS were randomly assigned to one of two prophylactic interventions [n=30/group]: (1) ondansetron 4 mg and ranitidine 50 mg before the induction of sevoflurane anesthesia [TIVA‐SF] group); and (2) propofol at 50–150 mcg/kg/minute + remifentanil 0.1 mcg/kg/min; (TIVA‐PR group). PONV incidence and severity was monitored immediately after GS for 24 hours. Recovery was assessed with a simulated wake up test and a simple behavioral score to assess overall recovery. The POP was assessed in each group via the visual analogue scale (VAS). The incidence of PONV was similar in the TIVA‐SF and TIVA‐PR groups during the 24 hours post GS [pGS], [TIVA‐SF=30.0%; TIVA‐PR 33.0%]. pGS HR was similar in both groups, but the GS mean arterial pressure (MAP) was significantly lower after induction and higher during surgical incision in the TIVA group [TIVA‐PR > TIVA‐SF, P<0.05]. The MAP in the TIVA‐PR was better controlled throughout GS than in TIVA‐ SF [MAP TIVA –PR < TIVA‐ SF, p<0.05]. The mean pain rating [MPR] was 3.5±3.4 in the TIVA‐PR group and 5.4±2.9 in TIVA‐ SF, while MPR was 3.1±3.1 in the TIVA‐PR group and 5.6±1.6 in the TIVA‐SF group. In the TIVA‐PR group, 8 out of 30 patients reported a pain score [PS] > 4; In the TIVA‐SF group, 18 out of 30 patients reported a PS > 4. In conclusion, IV ranitidine and ondanestron immediately before induction of TIVA using SF resulted in a similar reduction in PONV in comparison to TIVA‐PR. The overall PS recovery and HR did not differ significantly in both groups. The MAP demonstrated a significant increase after intubation in both the TIVA‐SF and TIVA‐PR groups, but was lower in TIVA‐PR group throughout the remainder of surgery. Upon emergence from anesthesia, the POP, behavioral scores, and the pGS recovery time were similar in both groups, but indicate that MAP was better controlled during GS with the TIVA‐PR than the TIVA‐ SF regimen. Support or Funding Information Supported by Institutional Resources of USAT Colleges of Medicine and Graduate Studies and the Einstein Institute