A. ÖZTAŞ, E. ERKILIÇ, T. GÜMÜŞ, O. KANBAK

Midazolam postoperatif bulantı ve kusmayı etkiler mi?

Amaç: Postoperatif bulantı-kusma (POBK), derlenme ünitesinde ve hastanede kalış süresini uzatarak postoperatif dönemde morbiditeyi etkileyen komplikasyonlardan biridir. Çalışmamızda intraoperatif midazolamın POBK üzerine etkisinin ondansetron ile karşılaştırılmasını amaçladık. Gereç ve Yöntem: Randomize, prospektif, çift kör olarak planladığımız çalışmaya, Etik Kurul izni alındıktan sonra elektif tiroid, paratiroid cerrahisi geçirecek, onayı alınan ASA І ve ІІ 60 hasta dahil edildi. Operasyon sırasında tiroid ve paratiroid dokusu çıkarıldıktan sonra Grup M ye (n=30) 2 mg midazolam IV, Grup Oya (n=30) 4 mg ondansetron IV verildi. Cerrahi bitiminden 30 dakika önce parasetomol IV uygulandı. Hastaların; anestezi başlama-bitiş, operasyona başlama-bitiş zamanları, uyanma zamanları, Aldrete skorunun 10 oluncaya kadar geçen süre, postoperatif bulantı-kusma sıklıkları, OAS/S, VAS değerleri, ek antiemetik ihtiyacı 24 saat süreyle izlendi. Bulgular: Her iki gruptaki hastaların demografik verileri arasında fark yok iken, operasyon süresi Grup Oda daha uzun bulundu. Gruplar arasında toplam kullanılan fentanil miktarı, uyanma zamanları ve ek antiemetik ilaç gereksinimi yönünden istatistiksel olarak anlamlı farklılık görülmedi. Grup Oya göre Grup Mnin Aldrete skorlaması 10 oluncaya kadar geçen süre istatistiksel olarak anlamlı daha uzundu (p

Does midazolam affect postoperative nausea and vomiting?

Aim: Postoperative nausea and vomiting (PONV) is one of the complications in a prolonged length of stay in postoperative care unit and hospital and thus, affects postoperative morbidity. We aimed to compare the effects of intraoperative midazolam and ondansetron on PONV. Materials and Methods: Upon obtaining ethical committee consent, 60 patients (ASA I-II) agreed to participate in the randomized, prospective and double-blinded study for elective thyroid and parathyroid surgery were enrolled. Following removal of thyroid / parathyroid tissue the patients in Group M were administered midazolam IV 2 mg, and the patients in Group O were administered ondansetron IV 4 mg. Thirty minutes before the end of surgery the patients were given paracetamol. The duration of anesthesia and surgery, wake-up time, time until Aldrete score reached 10, nausea and vomiting frequency, OAS/S and VAS scores additional antiemetic need were recorded for 24 hours. Results: There were no differences between the two groups with respect to demographic parameters. However, the operation time for Group O was longer. The total amount of fentanyl used, wake-up time, and the need for additional antiemetics in the two groups were not significantly different. The time until Aldrete score reached was significantly longer in Group M than in Group O. (p<0.05). The vomiting frequency was higher in Group M than in Group O at the th 24 hour (p=0.005). Conclusion: In this study where the effects of midazolam and ondansetron on PONV were compared, it was determined that sedation achieved with midalozam may be effective in the early postoperative period.

PDF

___

1. Riad W, Altaf R, Abdullah A, Oudan H. Effect of midazolam, dexamethasone and their combination on prevention of nausea and vomiting following strabismus repair in children. Eur J Anaesthesiol 2007;24(8):697-701.
2. Andrew PL. Physiology of nause and vomiting. Br J Anaesth 1992;69 (7 Suppl 1):2S-19S.
3. Kovac AL. Prevention and treatment of postoperative nausea and vomiting. Drugs 2000;59(2):213-43.
4. Camu F, Lauwers MH, Verbessem D. Incidence and etiology of postoperative nause and vomiting. Eur J Anaesthesiol 1992;(Suppl 6):25-31.
5. Watcha MF, White PF. Postoperative nausea and vomiting its etiology, treatment and prevention. Anaesthesia 1992;77(1):51-5.
6. Bauer K,Dom P.M, Ramirez AM, OFlaherty JE. Preoperative intravenous midazolam: Benefits beyond anxiolysis. J Clin Anesth 2004;16(3):177-83.
7. Unlugenc H,Guler T, Gunes Y, Isık G. Comparative study of the antiemetic efficacy of ondansetron, propofol and midazolam in the early postoperative period. Eur J Anaesthesiol 2004;21(1):60-5.
8. Ewalenko P, Janny S. Antiemetic effect of subhypnoticdoses of propofol after thyroidectomy. Br J Anaesth 1996;77(4):463-7.
9. Wetchler BV. Postoperative nausea and vomiting in day-case surgery. Br J Anaesth 1992:69(l):33-9.
10. Tarhan O, Canbay O, Celebi N, Uzun S. Subhypnotic doses of midazolam prevent nausea and vomiting during spinal anesthesia for cesarean section. Minerva Anestesiol 2007;73(12):629-33.
11. Bunce KT, Tyers MB. The Role of 5-HT in postoperative nausea and vomiting. Br J Anaesth 1992;69(7 Suppl 1):60S-262S.
12. DiFlorio T, Goucke CR. The effect of midazolam on persistent postoperative nausea and vomiting. Anaesth Intensive Care 1999;27(1):38-40.
13. Splinter WM, MacNeill HB, Menard EA, Rhine EJ, Roberts DJ, Gould MH. Midazolam reduces vomiting after tonsillectomy in children. CJA 1995;42(3):201-3.
14. Sanjay OP, Tauro DI. Midazolam: An effective antiemetic after cardiac surgery - A clinical trial. Anesth Analg 2004;99(2):339-43.
15. Lee Y, Wang JJ, Yang YL. Midazolam vs ondansetron for preventing postoperative nausea and vomiting. Anaesthesia 2007;62(1):18-22.
16. Polati E, Verlato G, Finco G, et al. Ondansetron versus metoclopramide in thetreatment of postoperative nausea and vomiting. Anesth Analg 1997;85(2):395-9.
17. Kim WJ, Kang H, Shin HY, et al. Ramosetron, midazolam, and combination of ramosetron and midazolam for prevention of postoperative nausea and vomiting: A prospective, randomized, double-blind study. J Int Med Res (accessed online 13.06.2013; DOI: 10.1177/0300060513485864).
18. Domino KB, Anderson E, Polissar N. Comparative efficacy and safety of ondansetron, droperidol, and metoclopramide for preventing postoperative nausea and vomiting. Anesth Analg 1999;88(6):1370-9.
19. Gan TJ. Risk factors for postoperative nausea and vomiting. Anesth Analg 2006;102(6):1884-98.