Orta kulak cerrahisi sonrasında oluşan bulantı ve kusmada droperidol, metoklopramid, propofol ve ondansetronun etkinliği
A m aç : Orta kulak cerrahisi sonrası oluflan bulantı-kusmanın profilaktik tedavisinde düflük doz propofol, metoklopramid, on- dansetron ve droperidolün etkinlik ve güvenilirliği rastgele se- çimli, çift-kör ve prospektif bir çalıflma düzeneğiyle arafltırıldı. Hastalar ve Yöntemler: Kronik otit veya sekeli nedeniyle orta kulak cerrahisi uygulanan, ASA I-II 101 hasta rastgele seçimle befl gruba ayrıldı. Ekstübasyondan befl dakika önce her bir gruba propofol n=21, 0.5 mg/kg , droperidol n=19, 20 mg/kg , metoklopramid n=23, 0.2 mg/kg , ondansetron n=21, 4 mg ve plasebo n=20, %0.9 NaCl intravenöz olarak uygulandı. Bulgular: Ameliyattan sonraki ilk üç saatlik dönemde dro- peridol alan hastaların hiçbirinde, ondansetron ve propofol gruplarının %71.4’ünde, metoklopramid grubunun %52.1’inde ve kontrol grubunun %35’inde bulantı-kusma görülmedi. Üç ile 24 saat arasındaki dönemde ise bulantı- kusmayı en iyi kontrol eden ajanın ondansetron %90.4 olduğu görüldü; bunu droperidol %84.2 , propofol %57.1 , metoklopramid %47.8 ve plasebo %40 izledi. Erken ve geç dönemde bulantı-kusma görülmeyen hasta sayısı, metoklopramid grubu dıflında, kontrol grubundan anlamlı derecede fazla bulundu p
Anahtar Kelimeler:
Anestezi, genel, antiemetik/terapötik kullan ı m , droperidol/terapötik kullanım, kulak, orta/cerrahi, metoklopramid/ terapötik kullanım, ondansetron/terapötik kullanım, ameliyat sonrasıbulantı ve kusma/önleme ve kontrol, propofol/terapötik kullanım
The efficacy of droperidol, metoclopramide, propofol and ondansetron for the prevention of nausea and vomiting following middle ear surgery
Objectives: The efficacy and reliabilrty of prophylactic antiemetic therapy with low dose propofol, droperidol, metoclopramide and ondansetron were evaluated in a randomized, double- blind, and prospective design.Patients and Methods: A total of 101 ASA l-ll patients 34 females, 67 males; age range 16 to 53 years undergoing middle ear surgery for chronic otitis media or its sequelae were randomly assigned to receive prophylactic antiemetic therapy with propofol n=21,0.5 mg/kg , droperidol n=19,20 mg/kg , metoclopramide n=23, 0.2 mg/kg , ondansetron n=21,4 mg , and placebo n=20, 0.9% NaCI . Ali drugs were administered intravenously five minutes before extubation.Results:İn the early postoperative period 0 to 3 hours , the percentages of patients free from nausea and vomiting were 100% with droperidol, 71.4% with ondansetron and propofol, 52.1% with metoclopramide, and 35% with placebo.Ondansetron 90.4% was found the most effective to pre- vent and control nausea and vomiting during the postopera tive 3 to 24 hours, follovved by droperidol 84.2% , propofol 57.1% , metoclopramide 47.8% , and placebo 40% .Compared with Controls, the number of patients vvithout nau sea and vomiting was significantly greater in each treatment group but metoclopramide p
Keywords:
Anesthesia, general, antiemetics/therapeutic use, droperidol/therapeutic use, ear, middle/surgery, metoclopramide/ therapeutic use, ondansetron/therapeutic use, postoperative nausea and vomiting/prevention & control, propofol/therapeutic use,
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- Watcha MF, White PF. Postoperative nausea and vom- iting. Its etiology, treatment, and pre v e n t i o n . Anesthesiology 1992;77:162-84.
- Honkavaara P, Saarnivaara L, Klemola UM. Pre v e n t i o n of nausea and vomiting with transdermal hyoscine in adults after middle ear surgery during general anaesthe- sia. Br J Anaesth 1994;73:763-6.
- Reinhart DJ, Klein KW, Schroff E. Transdermal scopo- lamine for the reduction of postoperative nausea in outpatient ear surgery: a double-blind, randomized study. Anesth Analg 1994;79:281-4.
- Fujii Y, Toyooka H, Tanaka H. Granisetron reduces the incidence of nausea and vomiting after middle ear surgery. Br J Anaesth 1997;79:539-40.
- Honkavaara P. Effect of transdermal hyoscine on nau- sea and vomiting during and after middle ear surgery under local anaesthesia. Br J Anaesth 1996;76:49-53.
- Liu YH, Li MJ, Wang PC, Ho ST, Chang CF, Ho CM, et al. Use of dexamethasone on the prophylaxis of nausea and vomiting after tympanomastoid surg e r y. Laryngoscope 2 0 0 1 ; 111 : 1 2 7 1 - 4 .
- Honkavaara P. Effect of ondansetron on nausea and vomiting after middle ear surgery during general anaesthesia. Br J Anaesth 1996;76:316-8.
- Fujii Y, Toyooka H, Tanaka H. Prophylactic anti-emet- ic therapy with granisetron, droperidol and metoclo- pramide in female patients undergoing middle ear surgery. Anaesthesia 1998;53:1165-8.
- Fujii Y, Toyooka H, Tanaka H. Prophylactic antiemetic therapy with a combination of granisetron and dexam- ethasone in patients undergoing middle ear surg e r y. Br J Anaesth 1998;81:754-6.
- Fujii Y, Tanaka H, Kobayashi N. Prevention of postoper- ative nausea and vomiting with antiemetics in patients u n d e rgoing middle ear surgery: comparison of a small dose of propofol with droperidol or metoclopramide. A rch Otolaryngol Head Neck Surg 2001;127:25-8.
- Fujii Y, Tanaka H, Kobayashi N. Prevention of nausea and vomiting after middle ear surgery: granisetron versus ramosetron. Laryngoscope 1999;109:1988-90.
- B o rgeat A, Wi l d e r-Smith OH, Saiah M, Rifat K. Subhypnotic doses of propofol possess direct antiemetic properties. Anesth Analg 1992;74:539-41.
- Leeser J, Lip H. Prevention of postoperative nausea and vomiting using ondansetron, a new, selective, 5- HT3 receptor antagonist. Anesth Analg 1991;72:751-5.
- Ishizaki H, Pyykko I, Aalto H, Starck J. Tullio phe- nomenon and postural stability: experimental study in normal subjects and patients with vertigo. Ann Otol Rhinol Laryngol 1991;100:976-83.
- Yalçın fi, Erhan ÖL, Akduracak O, Çelik O, Öztürk A, Bolat E, ve ark. N2O anestezisi ile oluflan orta kulak basınç değifliklikleri ve postoperatif kusma. In: Türk Otorinolarengoloji XX. Ulusal Kongresi Kitabı; 9-13 Ekim 1989; Girne, Kıbrıs. İstanbul: Erol Ofset; 1989. s. 258-60.
- Ku PK, Tong MC, Lo P, van Hasselt CA. Efficacy of ondansetron for prevention of postoperative nausea and vomiting after outpatient ear surgery under local anesthesia. Am J Otol 2000;21:24-7.
- Cohen MM, Duncan PG, DeBoer DP, Tweed WA. The postoperative interview: assessing risk factors for nau- sea and vomiting. Anesth Analg 1994;78:7-16.
- Jellish WS, Thalji Z, Fluter E, Leonetti JP. Ondansetron versus droperidol or placebo when given prophylacti- cally for the prevention of postoperative nausea and vomiting in patients undergoing middle ear proce- dures. J Clin Anesth 1997;9:451-6.
- Ünal A, Erk G, Özcan M, Uğur A, Göğüs N. Kronik süpüratif otitis media cerrahisinde sevofloran ve propofol anestezisi. Otoskop 2000;2:55-60.
- ISSN: 2602-4837
- Yayın Aralığı: Yılda 4 Sayı
- Başlangıç: 1991
- Yayıncı: İstanbul Üniversitesi
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