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

Multimodal prophylaxis for postoperative nausea and vomiting (PONV) has been recommended, even in low-risk patients. Midazolam is known to have antiemetic properties. We researched the effects of adding midazolam to the dual prophylaxis of ondansetron and dexamethasone on PONV after gynecologic laparoscopy. In this prospective, randomized, double-blinded trial, 144 patients undergoing gynecological laparoscopic surgery under sevoflurane anesthesia were randomized to receive either normal saline (control group, n = 72) or midazolam 0.05 mg/kg (midazolam group, n = 72) intravenously at pre-induction. All patients were administered dexamethasone 4 mg at induction and ondansetron 4 mg at the completion of the laparoscopy, intravenously. The primary outcome was the incidence of complete response, which implied the absence of PONV without rescue antiemetic requirement until 24 h post-surgery. The complete response during the 24 h following laparoscopy was similar between the two groups: 41 patients (59%) in the control group and 48 patients (72%) in the midazolam group (p = 0.11). The incidence of nausea, severe nausea, retching/vomiting, and administration of rescue antiemetic was comparable between the two groups. The addition of 0.05 mg/kg midazolam at pre-induction to the dual prophylaxis had no additive preventive effect on PONV after gynecologic laparoscopy.

Granisetron extended-release subcutaneous injection versus palonosetron infusion for preventing chemotherapy-induced nausea and vomiting: A cost analysis.

e24093 Background: Unscheduled hydrations (UHs) can significantly increase the cost of care in patients receiving moderately or highly emetogenic chemotherapy (MEC or HEC). Granisetron extended-release subcutaneous injection (GERSC) is a unique formulation of granisetron for prevention of acute and delayed chemotherapy-induced nausea and vomiting (CINV). Limited data are available regarding the impact of GERSC on cost of UHs compared to other antiemetics. Objective: Assess costs of an UHs associated with breakthrough CINV following GERSC or palonosetron (PALO) for preventing CINV in patients receiving MEC or HEC. Methods: Retrospective analysis of medical records from a single multicenter community-based practice involving patients receiving MEC or HEC with a 3-drug antiemetic regimen (neurokinin-1 receptor antagonist, dexamethasone, and either GERSC or PALO). Cost of care analysis for GERSC and PALO was based on maximum per-unit Medicare reimbursement for UHs, rescue antiemetic drugs and administration, laboratory, and office evaluations. Results: 182 patient records (n = 91 GERSC; n = 91 PALO) were evaluated. A lower number of median UHs per-patient were observed following GERSC versus PALO (HEC, 3 vs 5) and (MEC, 2 vs 3). Mean cost of care related to UHs was significantly lower per-patient following GERSC ($296, n=91) versus palonosetron ($837, n=91) ( P < 0.0001), including when the subset analysis was restricted to those patients requiring hydration (Table).When analyzing individual components of care, hydration (CPT codes 96360 and 96361) costs per-patient receiving HEC or MEC were lower following GERSC ($62, n=91) versus PALO ($253, n=91) ( P < 0.0001). Lower per-patient costs were observed following GERSC in all components of care except rescue antiemetic drug costs in MEC patients. Conclusions: GERSC reduced total per-patient costs of care associated with UHs visit relative to PALO in patients receiving HEC or MEC.[Table: see text]

The effectiveness of ramosetron and ondansetron for preventing postoperative nausea and vomiting after arthroscopic rotator cuff repair: a randomized controlled trial

Background Arthroscopic rotator cuff repair is a painful procedure, and treatment of emetic events associated with drugs used in the current multimodal pain management remains challenging. This study aimed to evaluate the effectiveness of ramosetron or ondansetron to relieve postoperative nausea and vomiting (PONV) and pain after arthroscopic rotator cuff repair. Methods In total, 122 consecutive patients undergoing arthroscopic rotator cuff repair were randomly allocated into three groups: ramosetron group (n = 39), ondansetron group (n = 43), and control group (n = 40). Then, 0.3 mg of ramosetron or 8 mg of ondansetron was administered intravenously at the end of surgery according to group. All patients received general anesthesia and multimodal pain management protocol including preemptive analgesic medication, fentanyl-based intravenous patient-controlled analgesia, and postoperative analgesic medication. Incidence of emetic events, rescue antiemetic requirements (10 mg of metoclopramide, IV), complete response, pain level, and side effects were recorded in three periods: 0–6, 6–24, and 24–48 h postoperatively. The severity of nausea and pain was evaluated using a visual analog scale. Results The ramosetron group tended to have a lower incidence and severity of nausea during the 6- to 24-h postoperative period and fewer rescue antiemetic drug requirements during the 0- to 48-h period than the control group, showing statistical significance. Additionally, the frequency of complete response of the ramosetron and ondansetron groups was significantly higher than that of the control group. No difference was found among the groups in the pain level except during the 0- to 6-h period. The two groups have a higher complete response during the 6- to 24-h period than the control group. Conclusions Ramosetron use led to a lower incidence, mild severity of nausea, and reduced use of rescue antiemetic drug after arthroscopic rotator cuff repair during the 6- to 24-h postoperative period than the control. Level of evidence Level I, randomized controlled trials, treatment study

COMPARISION OF ONDANSETRON VERSUS DEXAMETHASONE FOR PREVENTION OF NAUSEAAND VOMITING IN DIAGNOSTIC LAPAROSCOPIC GYNAECOLOGICAL PROCEDURES

BACKGROUND: Post-operative nausea and vomiting (PONV) affects 30-40% of patients after general anaesthesia.[11] AIMS: To compare the effect of Ondansetron and Dexamethasone for prevention of nausea and vomiting in diagnostic gynaecological laparoscopy. METHODS: Ethical committee approval was taken. Consent was obtained. Patients were divided into 2 groups of 30 each. General anaesthesia was administered to all patients. Inj. Ondansetron 0.15 mg/kg i.v. was given to patients of group O. Injection Dexamethasone 0.2 mg/kg IV was given to patients of group D. Patients were monitored for nausea, vomiting, retching, pain score, side effects and requirement of rescue antiemetic. RESULTS: Inj. Dexamethasone is better than Inj. Ondansetron for prevention of P.O.N.V. in diagnostic gynaecological laparoscopy.

COMPARATIVE EVALUATION OF SINGLE DOSE PALONOSETRON AND GRANISETRON IN MIDDLE EAR SURGERIES FOR PREVENTION OF POSTOPERATIVE NAUSEA AND VOMITING.

Background and aims: Palonosetron 5HT 3 antagonist have been evaluated in delayed chemotherapy induced nausea and vomiting but its antiemetic efficacy after middle ear surgery is less clear which is high risk for post operative nausea and vomiting.( PONV). This study aimed to evaluate whether Palonosetron conferred any advantage over Granisetron in terms of duration of prophylaxis and its effect on the incidence and severity of PONV in patients undergoing middle ear surgeries (MES) when used as single dose prophylactic antiemetic. Methods: One hundred ASA I and II patients of either gender aged 18 to 60 were randomly assigned into group P (Palonosetron n=50) or group G( Granisetron n=50), by computerised randomisation. Analysis was done in terms of incidence and severity of nausea, vomiting and rescue antiemetic usage till 72 hours of surgery. Results: During 72 hours, group P had more number of complete responders than in group G (56% vs. 34%). This difference was more significant after 24hours. 50% of patients in group G as against 28% in group required rescue antiemetic. Conclusion: Single dose prophylactic Palonosetron 0.075 mg and 2.5 mg Granisetron conferred similar protection against postoperative nausea and vomiting for initial six hours postoperatively but Palonosetron was more effective than Granisetron for long term prophylaxis over 72 hours against PONV after MES without significant adverse effects.

The Effectiveness of Ramosetron and Ondansetron for Preventing Postoperative Nausea and Vomiting After Arthroscopic Rotator Cuff Repair: a Randomized Controlled Trial

BackgroundArthroscopic rotator cuff repair is a painful procedure, and treatment of emetic events associated with drugs used in the current multimodal pain management remains challenging. This study aimed to evaluate the effectiveness of ramosetron or ondansetron to relieve PONV and pain after arthroscopic rotator cuff repair.MethodsIn total, 122 consecutive patients undergoing arthroscopic rotator cuff repair were randomly allocated into three groups: ramosetron group (n=39), ondansetron group (n=43), and Control group (n=40). Then, 0.3 mg of ramosetron or 8 mg of ondansetron was administered intravenously at the end of surgery according to group. All patients received general anesthesia and multimodal pain management protocol including preemptive analgesic medication, fentanyl-based intravenous patient-controlled analgesia, and postoperative analgesic medication. Incidence of emetic events, rescue antiemetic requirements (10 mg of metoclopramide, IV), complete response, pain level, and side effects were recorded in three periods: 0–6, 6–24, and 24–48 h postoperatively. The severity of nausea and pain was evaluated using visual analogue scale.ResultsThe ramosetron group tended to have a lower incidence and severity of nausea during the 6- to 24-h postoperative period and fewer rescue antiemetic drug requirements during the 0- to 48-h period than the control group, showing statistical significance (p<0.05). Additionally, the frequency of complete response of the ramosetron and ondansetron groups was significantly higher than that of the Control group. No difference was found among the groups in the pain level except during the 0- to 6-h period. The two groups have a higher complete response during the 6- to 24-h period than the control group. ConclusionsRamosetron use led to a lower incidence, mild severity of nausea, and reduced use of rescue antiemetic drug after arthroscopic rotator cuff repair during the 6- to 24-h postoperative period than the control. Level of evidence : I, randomized controlled trials, treatment study

Comparison of three different prophylactic treatments for postoperative nausea and vomiting after total joint arthroplasty under general anesthesia: a randomized clinical trial

Background: Postoperative nausea and vomiting (PONV) after total joint arthroplasty is common and associated with delayed recovery. This study was performed to evaluate the efficacy of three different prophylactic regimens for PONV after total joint arthroplasty under general anesthesia. Methods: Patients undergoing primary total hip or knee arthroplasty were randomized to Group A (8 mg ondansetron, n= 108), Group B (10 mg dexamethasone plus mosapride, n= 108), or Group C (three doses of 10 mg dexamethasone plus mosapride, n=116). The primary outcome was the total incidence of PONV during postoperative 48 hours. The secondary outcomes were complete response, rescue antiemetic treatment, opioid consumption, time until first defecation, postoperative appetite score, satisfaction score, length of hospital stay, blood glucose level, and complications. Results: Patients in Group C experienced a lower incidence of total PONV (29.3%, p= 0.001), severe nausea (1.72%, p<0.001) and a higher incidence of complete response (70.69%, p=0.001) than did patients in Groups A and B. Moreover, less rescue antiemetic treatment and postoperative opioid consumption was needed in Group C (p<0.05). Additionally, a shorter time until first defecation, shorter length of stay, and better postoperative appetite scores and satisfaction scores were detected in patients in Group C. A slight increase in the fasting blood glucose level was observed in Group C, and the complications were comparable among the groups. Conclusion: Prophylactic use of mosapride and three doses of dexamethasone can provide better antiemetic effectiveness, postoperative appetite, bowel function recovery, and pain relief than a single dose or ondansetron only.

Comparison of three different prophylactic treatments for postoperative nausea and vomiting after total joint arthroplasty under general anesthesia: a randomized clinical trial

Background: Postoperative nausea and vomiting (PONV) after total joint arthroplasty is common and associated with delayed recovery. This study was performed to evaluate the efficacy of three different prophylactic regimens for PONV after total joint arthroplasty under general anesthesia.Methods: Patients undergoing primary total hip or knee arthroplasty were randomized to Group A (8 mg ondansetron), Group B (10 mg dexamethasone plus mosapride), or Group C (three doses of 10 mg dexamethasone plus mosapride). The primary outcome was the incidence of PONV. The secondary outcomes were complete response, rescue antiemetic treatment, opioid consumption, time until first defecation, postoperative appetite score, satisfaction score, length of hospital stay, blood glucose level, and complications.Results: Patients in Group C experienced a lower incidence of severe PONV (1.72%, p<0.001) and a higher incidence of complete response (70.69%, p=0.001) than did patients in Groups A and B. Moreover, less rescue antiemetic treatment and postoperative opioid consumption was needed in Group C (p<0.05). Additionally, a shorter time until first defecation, shorter length of stay, and better postoperative appetite scores and satisfaction scores were detected in patients in Group C. A slight increase in the fasting blood glucose level was observed in Group C, and the complications were comparable among the groups.Conclusion: Prophylactic use of mosapride and three doses of dexamethasone can provide better antiemetic effectiveness, postoperative appetite, bowel function recovery, and pain relief than a single dose or ondansetron only.

Olanzapine as a rescue antiemetic in hematopoietic stem cell transplant

Background Chemotherapy-induced nausea and vomiting occurs in up to 80% of patients undergoing chemotherapy treatment and is associated with a deterioration in quality of life. Olanzapine is an atypical antipsychotic antagonist blocking a variety of neurotransmitters in the nausea and vomiting pathophysiology. Objectives The primary objective of this study is to determine whether olanzapine is associated with improved breakthrough nausea and vomiting in patients undergoing hematopoietic stem cell transplant. Secondary outcomes include number of documented emesis episodes, an evaluation of patient oral intake, and number of rescue antiemetic agents administered after olanzapine initiation. Methods This is a retrospective cohort review examining the effects of olanzapine for the treatment of breakthrough nausea and vomiting following hematopoietic stem cell transplant. Patients undergoing autologous or allogeneic hematopoietic stem cell transplant between January 2014 and October 2017 were included. Results A total of 150 patients were included in the study. Olanzapine use was associated with a complete response in 30% of patients for breakthrough chemotherapy-induced nausea and vomiting (p < 0.0001). An improvement in nausea (p < 0.0001) and vomiting (p = 0.02) was also observed in patients. Olanzapine administration was associated with lower as needed antiemetic usage (p < 0.0001) as well as fewer emesis episodes (p < 0.0001) but had no effect on oral intake (p = 0.13). Conclusions Olanzapine was associated with significant improvements in breakthrough nausea and vomiting control while reducing the number of emesis episodes and required antiemetic doses in the hematopoietic stem cell transplant population. Olanzapine may be beneficial in optimizing antiemetic regimens for breakthrough chemotherapy-induced nausea and vomiting control in patients undergoing hematopoietic stem cell transplant.

A comparative study of granisetrone, dexamethasone and combination of granisetrone-dexamethasone as prophylaxis for postoperative nausea vomiting during laparoscopic surgeries

Background: In laparoscopic surgeries, insufflation with carbon dioxide triggers vagal afferents on the bowel and peritoneum which induces emesis by activating the vomiting center. It is hypothesized that combined antiemetics with different sites of activity would be more effective than one drug alone for the prophylaxis against PONV. So, the present study was planned to compare the efficacy of granisetron, dexamethasone and combination of granisetron with dexamethasone to prevent PONV.Methods: This randomized prospective double-blind study was performed on 120 patients, aged between 18 and 58 years of ASA physical status I and II of either sex undergoing laparoscopic surgeries under general anesthesia. Patients were randomized in three groups, group I (granisetrone 2 mg I.V.), group II (dexamethasone) 8 mg I.V., group III (granisetrone+dexamethasone) 2 mg+8 mg I.V. with 40 patients in each group. Complete response, incidence of nausea, vomiting, and rescue antiemetic were recorded at specified intervals.Results: A complete response (defined as no PONV and no need for another rescue antiemetic) was achieved in 75% of the patients given granisetron, 70% in dexamethasone and in 92.5% of the patients given granisetron plus dexamethasone (P <0.05). The overall cumulative incidences (0-24 hours) of PONV were 10 (25%) in the granisetron, 12 (30%) in the dexamethasone and 3 (7.5%) in the combination group. No difference in adverse events were observed in any of the groups.Conclusions: The prophylactic therapy of granisetron 2 mg plus dexamethasone 8 mg just before induction of anaesthesia is significantly effective in prevention of PONV in patients undergoing laparoscopic surgeries.