Efficacy of prophylactic droperidol, ondansetron or both in the prevention of postoperative nausea and vomiting in major gynaecological surgery. A prospective, randomized, double-blind clinical trial.

We conducted a prospective, randomized, double-blind clinical trial comparing droperidol 1.25 mg intravenously (i.v.) (group 1, n = 30), ondansetron 4 mg i.v. (group 2, n = 30), or both (group 3, n = 30) in the prevention of postoperative nausea and vomiting (PONV) in the first 24 h following major gynaecological procedures under combined general and epidural anaesthesia. PONV was analysed by a linear nausea/vomiting score, incidence of nausea and vomiting, and the need for antiemetic rescue. Our results showed a similar incidence of nausea and vomiting in all groups (G1 33%, G2 40%, G3 43%). However, when comparisons were made according to the time of assessment, combination therapy resulted in significantly lower PONV than droperidol in the first hour (0% vs. 13%, P < 0.05) and second hour (0% vs. 13%, P < 0.05), and than ondansetron on the first hour (0% vs. 13%, P < 0.05). A trend persisted up to the fourth hour but was not statistically significant in either group. In conclusion, droperidol and ondansetron are effective agents in the prevention of PONV, and their combination seems to provide slightly better results than either drug alone.

[Comparative study of circulatory response to tracheal intubation with atracurium and succinylcholine]. / Estudo comparativo das respostas circulatórias à intubação traqueal com atracúrio ou succinilcolina.

Changes in some circulatory parameters after orotracheal intubation (OTI) were investigated in 40 patients anesthetized with thiopental 5.0 mg.kg-1 and fentanyl 100 micrograms, receiving either atracurium 0.5 mg.kg-1 (n = 20) or succinylcholine 1.0 mg.kg-1 (n = 20) to facilitate intubation. In the succinylcholine group (SC), mean values of SAP, DAP, MAP, and HR rose significantly in relation to control at 30 sec and 2 min after OTI. In the atracurium group (A), mean values of SAP, DAP, and MAP rose significantly at 30 sec after OTI, however, contrary to the SC group, mean values of HR did not rise significantly after OTI. Mean values of the double product HR x SAP rose significantly at 30 sec, 2 min, and 5 min after OTI in the SC group, but only at 30 sec and 2 min after OTI in the A group. The magnitude of elevation of those circulatory parameters studied was always greater in the SC group than in the A group. The authors conclude that atracurium does not modify the nature of circulatory changes after OTI but is associated to such changes in a lesser degree when compared to succinylcholine in a standard induction technique with thiopental/fentanyl.