Dexamethasone plus ondansetron for prevention of postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy: a comparison with dexamethasone alone.

OBJECTIVE: To compare the efficacy of combination of dexamethasone plus ondansetron with dexamethasone alone for postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy. STUDY DESIGN: Double blinded randomized controlled clinical trial. PLACE AND DURATION OF STUDY: Department of Anaesthesiology, Surgical Intensive Care Unit and Pain Management, Dow University of Health Sciences and Civil Hospital, Karachi, from March 2007 to September 2007. PATIENTS AND METHODS: One hundred patients, both male and female, age 20 to 50 years, ASA Physical status I and II, scheduled for elective laparoscopic cholecystectomy under general anaesthesia were randomly allocated to two groups. Group A received dexamethasone (2 ml) plus ondansetron 4 mg (2 ml) prepared in two different syringes, and group B received dexamethasone 8 mg (2 ml) and normal saline (2 ml), prepared in two separate syringes just before induction of anaesthesia. Anaesthesia was standardized. For the first 24 hours after anaesthesia, the presence or absence of nausea and vomiting (by simply yes or no) was assessed by anaesthetist blinded to randomization. The rescue antiemetic (metoclopromide 10 mg) i.v., was given, if patient remained nauseous for more than 15 minutes, or experience retching or vomiting during study period. RESULTS: In comparison to dexamethasone group, the frequency of nausea and vomiting was clinically and statistically lower in dexamethasone -- ondansetron group (p=0.035). Use of rescue antiemetic was significantly higher in dexamethasone group (p=0.022). Two patients in group A and one patient in group B experienced peri-anal itching at time of giving dexamethasone, none of our patients experienced headache, flushing or other side effects. CONCLUSION: Combination of dexamethasone plus ondansetron is more effective in preventing postoperative nausea and vomiting than dexamethasone alone when used for prophylaxis of PONV before the induction of anaesthesia in patients undergoing laparoscopic cholecystectomy.

Intravenous ketamine attenuates injection pain and arterial pressure changes during the induction of anesthesia with propofol: a comparison with lidocaine.

OBJECTIVE: To compare the effects of lidocaine and ketamine pretreatment on injection pain and hypotension due to propofol induction. DESIGN: Double blinded randomized controlled clinical trial. Place and Duration of the Study: Department of Anesthesiology, Surgical Intensive Care Unit and Pain Management, Dow University of Health Sciences and Civil Hospital, Karachi from February 2005 to December 2005. PATIENTS AND METHODS: One hundred patients, age 20-60 years, of either gender, ASA I and II scheduled for elective gynaecological, urological, orthopedic or general surgical procedures under general anesthesia were randomly allocated into two groups i.e. group A to receive ketamine 0.5 mg/kg in volume of 2 ml with venous occlusion and group B to receive 2 ml of 1% lidocaine with venous occlusion as pretreatment before propofol induction. Venous occlusion was performed using rubber tourniquet after elevating the arm for 30 seconds, which was released 60 seconds after giving the pretreatment bolus and anesthesia was induced with propofol (2 mg/ml). Fifteen seconds after injection of 25%, the calculated dose of propofol and severity of injection pain was evaluated. Heart rate (HR) and noninvasive blood pressure were recorded pre-operatively, just before propofol induction, after propofol induction, immediately after intubation and 3 minutes after intubation. RESULTS: Comparing the lidocaine group, the intensity and incidence of pain after propofol injection was lower in ketamine group but remained statistically insignificant. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were significantly higher in ketamine group after induction with propofol. The maximum fall in SBP from baseline in ketamine group was 16% and 29.1% in lidocaine group, while maximum decrease in DBP in ketamine group was found to be12.66% vs. 26.47% in lidocaine group. There was no significant change in heart rate from baseline in either group. CONCLUSION: Ketamine pre-treatment with venous occlusion is an effective method in reducing pain and providing hemodynamic stability after propofol induction.

Intrathecal fentanyl as adjunct to hyperbaric bupivacaine in spinal anesthesia for caesarean section.

OBJECTIVE: To compare the effect of adding fentanyl to intrathecal bupivacaine on the onset, duration and quality of spinal anesthesia and its effect of mother and neonate. DESIGN: Single blind randomized controlled clinical trial. PLACE AND DURATION OF STUDY: Department of Anesthesiology, Surgical Intensive Care Unit and Pain Management, Dow University of Health Sciences and Civil Hospital, Karachi, from January 2003 to June 2004. PATIENTS AND METHODS: Sixty young adult females, ASA physical status I and II, with singleton pregnancy undergoing elective or emergency cesarean section under spinal anesthesia were randomly allocated to receive spinal anesthesia either by using 0.75% hyperbaric bupivacaine 1.5 ml with 0.25 ml normal saline or 0.75% hyperbaric bupivacaine 1.5 ml with 0.25 ml fentanyl (12.5 microg). Blood pressure, heart rate, respiratory rate, oxygen saturation, sensory level, motor block, pain score and side effects were observed every 2 minutes for first 20 minutes, then at-5 minute interval throughout the surgery, thereafter at 30 minutes interval until the patient complained of pain. RESULTS: Comparing the bupivacaine group, time to achieve highest sensory level was significantly shorter in fentanyl group (*p < 0.05), while the duration of complete analgesia (time from injection to first report of pain) lasted significantly more longer in fentanyl group (184+/-20 minutes) than bupivacaine group (126+/-10 minutes). Duration of effective analgesia was also significantly more prolonged in fentanyl group (p < 0.05). There was no significant difference in the incidence of side effects between the two groups. CONCLUSION: Addition of fentanyl to intrathecal bupivacaine results in faster onset with improved peri-operative anesthesia without increasing the side effects.