Banu AYHAN, Nalan ÇELEBİ, Varol ÇELİKER, Elif BAŞGÜL, Ülkü AYPAR

Çocuklarda tonsillektomi ve adenoidektomi operasyonlarından sonra gelişen bulantı-kusma oranlarına midazolam ve ondansetronun etkilerinin karşılaştırılması

Amaç: Genel anestezi altındaki çocuklarda gözlenen bulantı-kusma; çok yaygın ve istenmeyen bir yan etkidir. Bu çalışmada; tonsillektomi ve adenoidektomi operasyonlarından sonra, ondansetron ve midazolanun bulantı-kusma insidansına etkilerini araştırmak amaçlanmıştır. Yöntem: Çalışmamız randomize, prosrektifve çift kör olarak planlanmıştır. Tonsillektomi ve adenoidektomi planlanan; 15-14 yaşlarında 60 hasta çalışmaya dahil edildi. Midazolam premedikasyonunu takiben, hastalar midazolam (MC) (n:20), kontrol (KG) (n;21) ve ondansetron (OG) (n:l9) grubu olarak üçe ayrıldı. Anestezi indiiksiyonu sevojluran. tiyopental. vekuronyum, fentanil ile yapıldı. Entiibasyon sonrasında intravenöz olarak; MG'na 75/ıg kg' midozolam, OG'na 150 pg kg' ondansetron, KG'na 5ml SF uygulandı. O,, N20 ve sevofluıanla anestezi idamesi sağlandı. Derlenme ve günübirlik cerrahi ünitesinde; CHEOPS (Children's Hospital of Eastern Ontario Pain Scale) skoru> 6 olan hastalara 0J5 pg kg' (i.v.) fentanil ve 10 pg kg' (po/i.m.) asetaminofen; postoperatif bulantı-kusma skoru (PONV); 3 olanlara 150 pg kg' (i.v.) metoklopramid uygulandı. Günübirlik cerrahi ünitesine gelişlerinden 45 dakika sonra ve postoperatif 24 saat içinde sıvı oral alım kaliteleri (OAK) ve PONX' insidansları değerlendirildi. Bulgular: Demografik veriler, ünitelerde kalma süreleri, iinitelerdeki PON\' ile OAK'leri, ek ilaç uygulanma miktarları gruplar arasında farklı değildi. MG ile OG arasında PONV 24. saat değerleri açısından istatistiksel olarak bir fark bulunamadı (p> 0.05). 24.saat OAK'leri ondansetron grubunda daha fazla olmak üzere, iiç grupta da farklıydı (p< 0.05). Sonuç: Ondansetron ile daha belirgin olacak şekilde; ondansetron ve midazolam; kontrol grubuna göre 24 saat PONV insidansmı azaltarak; OAK'sini postoperatif dönemde arttırmaktadır.

Comparison of the effects of midozolam and ondansetron by accounting the rate of nause and vomiting after tonsillectomy and adenoidectomy surgery in children

Objective: Nausea and vomiting are common and unpleasant side effects of children undergoing general anesthesia. We investigated the antiemetic effects of ondansetron and midazolam by accounting the incidence of nausea and vomiting after tonsillectomy and adenoidectomy. Method: A randomized, double-blind trial was performed. Sixty children, 1,5-14 years of age who were undergoing tonsillectomy and adenoidectomy were included in this study. After the premedication with midazolam, patients were divided as midazolam group (GM), ondansetron group (GO) and control group (GC)s. Anaesthesia was induced with sevoflurane, thiopental, vecuronium and fentanyl. After the intubation; patients received 75 μg kg-1 midazolam in GM, 150 μg kg-1 ondansetron in GO and 5 ml SF solution in GC. Anaesthesia was maintaned by N2O, sevoflurane and O2. After the operation, fentanyl (0,5 μg kg-1) was administered in post-anaesthetic recovery room (PAR) and acetominophen (10 μg kg-1, po/im) was given in the Day Care Surgical Unit (DCSU), if the CHEOPS (Children's Hospital of Eastern Ontorio Pain Scale) pain score was more than 6. Patients who have 3 score of PONV in PAR or DCSU was administered metocloropamid (150 μg kg-1, i.v.). Patients were evaluated who arrived in DCSU after 45 min and 24th hours for the incidence of nausea, vomiting and quality of oral intake(QOI) . Results: The groups were similar with respect to demographic data, additional drugs reqruitment, duration of stay in the PAR and DCSU and PONV score in these units. There were no diffences between the GM and GO in 24th hrs of PONV scores (p> 0.05). OQI scores at the 24th hrs were different for all groups especially in the OG (p< 0.05). Conclusion: Being more pronounced with ondansetron; ondansetron and midazolam were found to increase the QOI by decreasing PONV score at the 24th hours.

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1. Heffernan AM, Rowbotham DJ. PONV-time for balanced antiemezis? Br J Anaesth 2000:85(5)t675-7.
2. Litman RS, Wu CL. Catanzaro FA. Ondansetron decreases emesis after tonsillectomy in children. Anesth Analg I994;78(3):478-81.
3. Pappas AL, Sukhani R, Hotaling AJ. Mikat-Stevens M. Javorski JJ. Donzelli J. Slıenoy K. The effect of preoperative dexamethasone on the immediate and delayed postoperative morbidity in children undergoing adenotonsiLlectomy. Anesth Analg 1998:87(1):57-61.
4. Sadhasivam S, Shende D, Madan R. Prophylactic ondansetron in prevention of postoperative nausea and vomiting following pediatric strabismus surgery. Anesthesiology 2000:92(4): 1035-42.
5. Weidmann C. Nunez J. Heffernan AM. Postoperative nausea and vomiting - time for balanced antiemesis (Correspondence). Anaesth Analg 2000:90:186-94.
6. Fujii Y. Current management of vomiting after tonsillectomy in children. Curr Drug Saf 2009:4(1 ):62-73.
7. Splinter W. MacNeil HB. Menard EA. Midozolam reduces vomiting after tonsillectomy in children. Can J Anaesth l995:42(3):20l-3.
8. Ayatollahi V, Behdad S, Hatami M. Moshtaghiun H, Baghianimoghadam B. Comparison of peritonsillar infiltration effects of ketamine and tramadol on post tonsillectomy pain: a double-blinded randomized placebo-controlled clinical trial. Croat Med J 2012:53(2): 155-61.
9. Gan TJ. Risk factors for postoperative nausea and vomiting. Anesth Analg 2006:102(6): 1884-98.
10. Sukhani R, Pappas AL. Lurie J. Hotaling AJ. Park A. Ruder E. Ondansetron and dolasetron provide equivalent postoperative vomiting control after ambulatory tonsillectomy in dexamethasone-pretreated children. Anesth Analg 2002:95(5): 1230-5.
11. Furst SR, Rodarte A. Prophylactic antiemetic treatment with ondansetron in children undergoing tonsillectomy. Anesthesiology 1994;81 (4 ):799-803.
12. Splinter WM. Rhine EJ. Roberts DW et al. Ondansetron is a better prophylactic antiemetic than droperidol for tonsillectomy in children. Can J Anaesth I995;42(10):848-51.
13. Rowbotham DJ. Current management of postoperative nausea and vomiting. Br J Anaesth 1992:69(7 Suppl l ):46S-59S.
14. Davis PJ. McGowan FX Jr, Landsman I. Maloney K. Hoffmann P. Effect of antiemetic therapy on recovery and hospital discharge time. A double-blind assessment of ondansetron, droperidol. and placebo in pediatric patients undergoing ambulatory surgery. Anesthesiology 1995:83(5):956-60.
15. Domino KB. Anderson EA. Poiissar NL, Posner KL. Comparative efficacy and safety of ondansetron, droperidol. and metoclopramidc for preventing postoperative nausea and vomiting: a meta-analysis. Anesth Analg 1999:88(6): 1370-9.
16. Culy CR, Blıana N, Plosker GL. Ondansetron: a review of its use as an antiemetic in children. Paediatr Drugs 2001:3(6):441-79.
17. Ummenhofer W. Frei FJ, Urwyler A. Kem C. Drewe J. Effects of ondansetron in the prevention of postoperative nausea and vomiting in children. Anesthesiology 1994:81(41:804-10.
18. Czarnetzki C. Elia N. Lysakowski C et al. Dexamethasone and risk of nausea and vomiting and postoperative bleeding after tonsillectomy in children: a randomized trial. JAMA 2008; 300(22):2621-30.
19. Bolton CM. Myles PS, Nolan T. Sterne J A. Prophylaxis of postoperative vomiting in children undergoing tonsillectomy: a systematic review and meta-analysis. Br J Anaesth 2006:97(5): 593-604.
20. Afman CE, Wclge JA, Steward DL. Steroids for posttonsillectomy pain reduction: meta-analysis of randomized controlled trials. Otolaryngol Head Neck Surg 2006:134(2): 181-6.
21. Steward DL. Welge JA. Myer CM. Do steroids reduce morbidity of tonsillectomy? meta-analysis of randomized trials. Laryngoscope 2001; 111(10): 1712-18.
22. Windfuhr J P. Chen YS. Propst EJ. GUldner C. The effect of dexamethasone on post-tonsillectomy nausea, vomiting and bleeding. Braz J Otorhinolaryngol 2011;77(3):373-9.
23. Henzi I, Walder B. Trainer MR. Dexamethasone for the prevention of postoperative nausea and vomiting: a quantitative systematic review. Anesth Analg 20QD;9O( 1): 186-94.
24. Splinter WM. Prevention of vomiting after strabismus surgery in children: dexamethasone alone versus dexamethasone plus low-dose ondansetron. Paediatr Anaesth 2001; 11 (5 ):591 -5.
25. Kearsley JH. Williams AM. Fiumara AM. Antiemetic superiority of lorazepam over oxazepam and methylprednisolone as premedicants for patients receiving cisplatin-containing chemotherapy. Cancer 1989:64(8): 1595-9.
26. Khalil SN. Berry JM. Howard G et al. The antiemetic effect of lorazepam after outpatient strabismus surgery in children. Anesthesiology 1992;77(5):915-9.
27. Di Florio T. The use of midazolam for persistent postoperative nausea and vomiting. Anaesth Intensive Care 1992:20(3):383-6
28. Takada K, Murai T. Kanayama T. Koshikawa N. Effects of midazolam and flunitrazepam on the release of dopamine from rat striatum measured by in vivo microdialysis. Br J Anaesth 1993:70(21:181-5.
29. Fujii Y, Itakura M. A prospective, randomized, double-blind, placebo-controlled study to assess the antiemetic effects of midazolam on postoperative nausea and vomiting in women undergoing laparoscopic gynecologic surgery. Clin Ther 2010: 32(9): 1633-7.
30. Riad W. Marouf II. Combination therapy in the prevention of PONV after strabismus surgery in children: granisetron. ondansetron, midazolam with dexamethasone. Middle East J Aneslhesiol 2009;20(3):431 -6.
31. Riad W. Altaf R. Abdulla A, Oudan H. Effect of midazolam, dexamethasone and their combination on the prevention of nausea and vomiting following strabismus repair in children. Eur J Anaesthesiol 2007:24(8):697-701.