Granisetron-deksametazon kombinasyonunun jinekolojik girişimlerde postoperatif bulantı ve kusma üzerine etkileri

Amaç: Postoperatif bulantı-kusma (POBK) anestezi sonrası en sık ortaya çıkan yan etkilerden biridir. POBK hastanın ameliyat sonrası derlenmesini, düzelmesini ve hastanede kalış süresini uzatır. Çalışmamızın amacı POBK’yı önlemeye yönelik profaktik olarak kullanılan granisetron (40 µ/kg) + deksametazon (4 mg) kombinasyonunun farklı anestezi modellerindeki etkinliğini araştırmaktır. Gereç ve Yöntem: Çalışmaya ASA 1–2 grubu, yaşları 18–70 arasında jinekolojik operasyon geçirecek 72 hasta alındı. Hastalar, Grup1 propofol-remifentanil (P-R), Grup 2 propofol-azot protoksit (P-N2 O), Grup 3 sevofurane azot protoksit (SN2 O), Grup 4 sevofurane-remifentanil-hava (S-R+H) olmak üzere randomize 18’erlik dört eşit gruba ayrıldı. İndüksyonda tüm gruplara 2-3 mg/kg propofol, 1 µ/kg remifentanil ve 0,2 mg/kg cis-atracuryum intravenöz verildi. Tüm gruplardaki hastalara indüksiyondan sonra 4 mg deksametazon bolus, 40 µ/kg granisetron infüzyon şeklinde (3 dk da) verildi. Postoperatif 48 saat hastaların bulantı-kusma, VAS skorları, ek antiemetik gereksinimleri kaydedildi ve oprasyonun son 10 dakikasında 1mg/kg tra- madol intravenöz uygulandı. Bulgular: Kırk sekiz saatlik takiplerde POBK, grup I (P+R)’de %27, grup II (P+ N2 O)’de %16, grup III (S+ N2 O)’de %38 ve grup IV (S+R+H)’de %48 oranında görüldü. Grup (P+ N2 O) ve grup (S+ N2 O)’de antiemetik gerekmezken, grup (P+R); %5.5 ve grup (S+R+H)’de ise; %11 oranında antiemetik gereksinimi oldu. Sonuç: Sonuç olarak jinekolojik operasyonlarda, değişik anestetik modellerde uygulanan granisetron, dexametazon kombinasyonu postoperatif bulantı, kusma ve ek antiemetik gereksinimi açısından anlamlı bir farklılık göstermedi.

The effect of granisetron dexamethasone combination on postoperative nausea and vomiting in gynecological operations

Objectives: Postoperative nausea and vomiting (PONV) is one of the most frequent adverse effects of anesthesia. PONV postpones hospital stays and also delays recover and getting better, of the patients. The objective of the current study is to compare effcacy of prophylactic granisetron (40 µ/kg) + dexamethasone (4 mg) combination against PONV in different anesthesia models. Materials and Methods: 72 patients with an age range of 18-72 years and ASA 1 or 2 were enrolled in the present study. The patients were assigned as group 1 propofolremifentanil (P-R), group 2 propofol- nitrous oxide (P- N2 O), group 3 sevofurane- nitrous oxide (S-N2 O) and group 4 sevofurane-remifentanyl-air (S-R+H). Inductions of the patients in all groups were made with intravenous 2-3 mg/kg propofol, 1µ/kg remifentanil and 0.2 mg/kg cisatracurium. 4 mg of dexamethasone by bolus and 40 µ/ kg of granisetron by infusion were administered to the patients in all groups after induction. During the last 10 minutes of the operation, 1mg/kg tramadol was administered. Postoperative nausea and vomiting, VAS scores, and additional antiemetic needs were recorded during postoperative 48 hours. Results: Postoperative 48 hours follow up revealed that PONV was seen 27%, 16%, 38%, 48% frequencies in (P+R), (P+ N2 O), (S+ N2 O), (S+R+H) groups, respectively. While antiemetic requirement was not observed in (P+ N2 O) and (S+ N2 O) groups, the patients in (P+R) and (S+R+H) groups needed additional antiemetic drugs with a frequency of 5.5% and 11% respectively. Conclusion: Granisetron, dexamethasone combination in different anesthetic models did not reveal signifcant difference in terms of postoperative nausea, vomiting, and additional antiemetic usage.

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