[Haloperidol or droperidol with dexamethasone for antiemetic prophylaxis in laparoscopic cholecystectomy]. / Haloperidol o droperidol asociados a dexametasona como profilaxis antiemética en colecistectomías laparoscópicas.

OBJECTIVES: To compare haloperidol to droperidol, both with dexamethasone, for antiemetic prophylaxis in elective laparoscopic cholecystectomy. MATERIAL AND METHODS: Prospective, randomized double-blind trial enrolling 75 ASA 1-2 patients who received anesthesia with propofol and remifentanil. After induction, 8 mg of intravenous dexamethasone was administered. After surgery, depending on group assignment, patients received 10 microg x kg(-1) of intravenous haloperidol (n = 25), 10 microg x kg(-1) of droperidol (n = 25), or physiologic saline solution (n = 25). Outcomes recorded were episodes of nausea or vomiting in the postoperative period (first 6 hours and/or 6-24 hours), requirement for antiemetic agents, morphine consumption, pain assessed on a visual analog scale, level of sedation, and adverse effects. RESULTS: Five patients in the haloperidol group, 6 in the droperidol group, and 13 in the control group experienced an episode of nausea or vomiting in the 24-hour postoperative period (P < .05 between the active treatment groups and the control group). One patient in the haloperidol group, 6 in the droperidol group, and 8 in the control group reported nausea in the first 6 hours (P < .05). Three patients in the haloperidol group, 1 in the droperidol group, and 8 in the control group reported nausea in the later postoperative period (6-24 hours) (P < .05, droperidol vs control). Three patients in the haloperidol group, 1 in the droperidol group, and 7 in the control group experienced late vomiting (P < .05, droperidol vs control). CONCLUSIONS: Either haloperidol or droperidol in combination with dexamethasone is more effective than dexamethasone alone for antiemetic prophylaxis after laparoscopic cholecystectomy.

Haloperidol o droperidol asociados a dexametasona como profilaxis antiemética en colecistectomías laparoscópicas / Haloperidol or droperidol with dexamethasone for antiemetic prophylaxis in laparoscopic cholecystectomy

OBJETIVOS: Comparar haloperidol y droperidol asociados a dexametasona como profilaxis antiemética en colecistectomías laparoscópicas electivas. MATERIALES Y MÉTODOS: Estudio prospectivo, randomizado, doble-ciego sobre 75 pacientes ASA I-III que recibieron anestesia con propofol y remifentanilo. Tras la inducción, se administraron 8 mg de dexametasona iv y al finalizar la intervención, según el grupo estudiado: 10 μg kg-1 de haloperidol iv (grupo H; n = 25), 10 μg kg-1 de droperidol (grupo D; n = 25) o suero fisiológico (grupo control; C; n = 25). Se registraron las náuseas y vómitos en el postoperatorio (6 primeras horas y 6-24 horas), necesidades de antieméticos, consumo de morfina, la escala visual analógica para dolor, el grado de sedación y efectos adversos. RESULTADOS: Cinco pacientes en el grupo haloperidol, seis en el grupo droperidol y trece en el grupo control presentaron algún episodio de náusea o vómito en las 24 horas (p < 0,05 grupos H y D versus C). Un paciente en el grupo H, 6 en el grupo D y 8 en el grupo C tuvieron náuseas en las primeras 6 horas (p < 0,05 grupo H versus grupo C). Tres pacientes en el grupo H, uno en el grupo D y ocho en el grupo C presentaron náuseas en el postoperatorio tardío (6-24 h) (p < 0,05 grupo D vs grupo C). 3 pacientes en el grupo H, 1 en el grupo D y 7 en el grupo C presentaron vómitos tardíos (p < 0,05 grupo D vs C). CONCLUSIONES: Haloperidol o droperidol en combinación con dexametasona son superiores a dexametasona sola como profilaxis antiemética en colecistectomías laparoscópicas

OBJECTIVES: To compare haloperidol to droperidol, both with dexamethasone, for antiemetic prophylaxis in elective laparoscopic cholecystectomy. MATERIAL AND METHODS: Prospective, randomized double-blind trial enrolling 75 ASA 1-2 patients who received anesthesia with propofol and remifentanil. After induction, 8 mg of intravenous dexamethasone was administered. After surgery, depending on group assignment, patients received 10 μg· kg-1 of intravenous haloperidol (n = 25), 10 μg·kg-1 of droperidol (n = 25), or physiologic saline solution (n = 25). Outcomes recorded were episodes of nausea or vomiting in the postoperative period (first 6 hours and/or 6-24 hours), requirement for antiemetic agents, morphine consumption, pain assessed on a visual analog scale, level of sedation, and adverse effects. RESULTS: Five patients in the haloperidol group, 6 in the droperidol group, and 13 in the control group experienced an episode of nausea or vomiting in the 24-hour postoperative period (P <.05 between the active treatment groups and the control group). One patient in the haloperidol group, 6 in the droperidol group, and 8 in the control group reported nausea in the first 6 hours (P <.05). Three patients in the haloperidol group, 1 in the droperidol group, and 8 in the control group reported nausea in the later postoperative period (6-24 hours) (P <.05, droperidol vs control). Three patients in the haloperidol group, 1 in the droperidol group, and 7 in the control group experienced late vomiting (P <.05, droperidol vs control). CONCLUSIONS: Either haloperidol or droperidol in combination with dexamethasone is more effective than dexamethasone alone for antiemetic prophylaxis after laparoscopic cholecystectomy

Less postoperative nausea and vomiting after propofol + remifentanil versus propofol + fentanyl anaesthesia during plastic surgery.

BACKGROUND: The effect of different opioids on postoperative nausea and vomiting (PONV) has not been conclusively determined yet, thus the aim of this study was to compare the incidence of PONV in propofol-anaesthetized patients receiving either fentanyl or remifentanil as opioid supplement. METHODS: Sixty ASA physical status I and II patients scheduled for plastic surgery gave their written informed consent for this prospective, randomized, double-blind study. Anaesthesia was induced with propofol, rocuronium and fentanyl (n = 30; 2 microg kg(-1)) or remifentanil (n = 30; 1 microg kg(-1)). After tracheal intubation, anaesthesia was maintained with propofol, oxygen in air and an infusion of the opioid studied, which was modified according to clinical criteria. Baseline postoperative analgesia was achieved with intravenous propacetamol + metamizol. Intravenous morphine was given if visual analogic scale (VAS) for pain was > or = 4 (scale 0-10) and metoclopramide was administered if a patient presented > or = 2 PONV episodes (nausea or vomiting) in less than 30 min. Postoperatively (2, 12 and 24 h), we registered VAS, rescue morphine consumption, number of patients with episodes of PONV and number of patients requiring metoclopramide. P < 0.05 was considered significant. RESULTS: There were no significant differences between groups in the demographic parameters, ASA physical status, propofol dose, VAS, and rescue morphine requirements. Fourteen patients in the fentanyl group and four in the remifentanil group presented PONV episodes 2-12 h postoperative hours' interval; (P < 0.05). Ten patients in the fentanyl group and four in the remifentanil group presented vomiting episodes in the same period (P < 0.05); and eight patients in the fentanyl group and one in the remifentanil group required metoclopramide; (P < 0.05). The number of postoperative PONV episodes were low, both in the 0-2-h period (n = 2 vs. n = 1, fentanyl and remifentanil, respectively) and in the 12-24-h period (n = 3 vs. n = 1). CONCLUSION: Propofol + fentanyl anaesthesia resulted in a higher incidence of PONV and requirements of antiemetic drugs in the period between 2 and 12 postoperative hours compared with propofol + remifentanil, in patients undergoing plastic surgery.