ESRA YÜKSEL ACI, Demet SERGİN, Taner BALCIOĞLU

Günübirlik genel anestezi ile diş tedavisinde postoperatif bulantı -kusmanın önlenmesinde metoklopramid in etkinliği

Amaç: Çalışmamızda günübirlik genel anestezi altında diş tedavisi yapılan hastaların postoperatif bulantı -kusma (POBK) tedav isinde metoklopramidin etkinliğinin belirlenmesi amaçlandı . Gereç ve Yöntem : Günübirlik genel anestezi altında diş tedavisi yapılan, ASA I -II 60 hastanın dosyaları geriye dönük olarak incelendi. Çalışmaya alınan 60 hastadan anestezi indüksiyonu sonrası cer rahi başlamadan önce iv 10 mg metoklopramid verilen hastalar (Grup 1) (n=30), antiemetik verilmeyen hastalar (Grup 2) (n=30) olarak adlandırıldı. Postoperatif derlenme ünitesinde hastalar 15, 30. dk, 1 . , 2. , 4. ve 6. saatlerde bulantı/kusma varlığı ve şidd eti açısından değerlendirilmişti. Olgulardaki bulantı/kusma şiddet skoru, 5 noktalı skala (0=bulantı yok, 1 =hafif bulantı, 2=orta şiddetli bulantı, 3=saatte 2 defadan daha az kusma, 4=saatte 2 defadan daha fazla kusma) kullanılarak ölçülmüştü. Ek antiemeti k alımı ve yan etkiler kaydedilmişti. Bulgular: Hastaların demografik verilerinde istatistiksel anlamlı fark yoktu. Postoperatif tüm ölçüm zamanlarında, bulantı/kusma skorları açısından iki grup arasında anlamlı bir farklılık bulunmadı (p>0.05). İki grupta da ek antiemetik gereksinimi ve yan etki gözlenmedi. Sonuç: Metoklopramid ve kontrol grubu arasında POBK ve ek antiemetik gereksinimi açısından anlamlı bir fark bulunmadı.

Efficacy of metoclopramide for prevention of postoperative nause a and vomiting in dental treatment under outpatient general anesthesia

Aim: This study retrospectively evaluates the efficacy of metoclopramide in preventing postoperative nausea and vomiting (PONV) in patients who had dental treatment under outpatient general anesthesia. Materials and Methods: The records of 60 ASA I-II patients who had dental treatment under outpatient general anesthesia were examined retrospectively. From 60 patients who were included in the study, patients who receieved metoclopramide 10 mg IV after anesthesia induction comprised Group 1 (n=30) and those who did not receive any antiemetic medication comprised Group 2 (n=30). The patients were assessed in the postoperative recovery unit in terms of presence and severity of nausea/vomiting at 15, 30 min and 1, 2, 4, and 6 hour. The nausea/vomiting severity scores of the patients were measured using a 5-point scale (0=no nausea, 1=mild nausea, 2=moderate nausea, 3=vomiting less than twice an hour, 4=vomiting more than twice an hour). Additional antiemetic drug administration and side effects were recorded. Results: There were no statistically significant differences in the patients demographic data. No significant difference was found between the two groups in terms of nausea/vomiting scores at any of the postoperative measurement times (p>0.05). There was no need for additional antiemetic medications or any side effects in any of the groups. Conclusion: No significant difference was shown between the metoclopramide and control groups in terms of PONV or the need for additional antiemetic medication.

PDF

___

1. White PF, Eng MR. Ambulatory (Outpatient) Anesthesia. In: Miller RD, Ericson LI, Fleisher LA, Wiener-Kronish JP, Young WL, (eds ) . Millers Anesthesia, 7th ed ition. United States of America : Churchill Livingstone, Elsevier, 2010;2419 -60.
2. Numazaki M, Fuji Y. Reduction of postoperati ve emetic episodes and analgesic requirements with dexamethasone in patients scheduled for dental surgery. J Clin Anesth 2005;17(3):182-6.
3. Moreno C, Veiga D, Pereira H, Martinho C, Abelha F. Postoperative nause and vomiting incidence, characteristics and risk factors - A prospective cohort study. Rev Esp Anestesiol Reanim 2013;60 (5):249 -56.
4. Gan TJ, Meyer T, Apfel CC, et al. Society for Ambulatory Anesthesia guidelines for the m anagement of p ostoperative n ausea and v omiting . Anesth Analg 2003;105:1615 -28.
5. Ve yrat-Follet C, Farinotti R, Palmer JL. Physiology of chemotherapy induced emesis and antiemetic therapy. Predictive models for evaluation of new compounds. Drugs 1997;53(2):206 -34.
6. Yis U, Ozdemir D, Duman M, Unal N. Metoclopramide induced dystonia in child ren: Two case reports. Eur J Emerg Med 2005;128(3):117 -19.
7. Cantekin K, Yıldırım MD, Delikan E, Cetin S. Postoperative discomfort of dental rehabilitation under general anesthesia. Pak J Med Sci 2014;30(4):784-8.
8. Habib AS, Gan TJ. Evidence -based management of postoperative nausea and vomiting: A review. Can J Anesth 2004;51(4):326 -41.
9. Kumar G1, Stendall C, Mistry R, et al. A comparison of total intravenous anaesthesia using propofol with sevoflurane or desfl urane in ambulatory surgery: Systematic review and meta -analysis. Anaesthesia 2014;69(10):1138 -50.
10. Polati E, Verlato G, Finco G, et al. Ondansetron versus metoclopramide in the treatment ofpostoperative nausea and vomiting. Anesth Analg 1997;85(2):395 -9.
11. Fujii Y, Tanaka H, Toyooka H. Prevention of nausea and vomiting in female patients undergoing breast surgery: A comparison with granisetron, properidol, metoclopramide and placebo. Acta Anaesthesiol Scand 1998;42(4):220 -4.
12. Quaynor H, Raeder JC. Incidence and severity of postoperative nausea and vomiting are similar after metoclopramide 20 mg and ondansetron 8 mg given by the end of laparoscopic cholecystectomies. Acta Anaesthesiol Scand 2002;46(1):109 -13.
13. Wallenborn J, Gelbrich G, Bulst D, et al. Prevention of postoperative nausea and vomiting by metoclopra mide combined with dexamethasone: randomised double blind multicentretrial. Br Med J 2006;333:324 7.
14. Karaman S, Günüşen İ, Ceylan A, et al. The effect of dexketoprofen trometamol on postoperative analgesia and morphine consumption in major gynecologic surg ery. Ege Journal of Medicine 2013;52(1):1 -6
15. Gülhaş N, Durmuş M, Yücel A, ve ark. Total abdominal histerektomilerde intravenöz deksketoprofen trometamol, lornoksikam ve parasetamolün etkinliklerinin karşılaştırılması. Türk Anest Rean Dergisi 2011;39(4):176 -81.
16. Henzi J, Walder B. Tramer MR. Metoclopramide in the prevention of postoperative nause and vomiting: a quantitative systematic review of randomized, placebo controlled studies. Br J Anaesth 1999; 83(5):761 -71.
17. Adam NV, Stojcic EG, Rasic Z, Cala Z, Mrsi c V, Smiljanic A. Comparison of dexamethasone, metoclopramide, and their combination in the prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy. Surg Endosc 2007;21(4):607 -12.
18. Mishriky BM, Habib AS. Metoclopramide for nause a nd vomiting prophylais during and after Caesarean delivery: A systematic review and meta -analysis. British Journal of Anaesthesia 2012;108(3):374 -83.
19. Alexander R, Fennelly M. Comparison of ondansetron, metoclopramide and placebo as premedicants to reduce n ause and vomiting after major surgery. Anaesthesia 1997;52(7):695 -703.
20. Talesh KT, Motamedi MH, Kahnamouii S . Comparison of ondansetron and metoclopramide antiemetic prophylaxis in maxillofacial surgery patients. Oral Surg Oral Med Oral Pathol Oral Radiol E ndod 2011;111(3):275 -7.
21. Entezariasl M , Khoshbaten M, Isazadehfar K, Akhavanakbari G. Efficacy of metoclopramide and dexamethasone for postoperative nausea and vomiting: a double -blind clinical trial. East Mediterr Health J 2010;16(3):300 -3.
22. Jo YY, Kim YB, Yang MR, Chang YJ. Extrapyramidal side effects after metoclopramide administration in a post-anesthesia care unit -A case report-. Korean J Anesthesiol. 2012;63(3):274 -6.
23. Fujii Y, Saitoh Y, Tanaka H, Toyooka H. Retraction Note to: Prevention of PONV with granisetron, droperidol or metoclopramide in patients with postoperative emesis. Can J Anaesth 2013;60(6):618 .