COMPARING THE EFFECT OF MIDAZOLAM AND METOCLOPRAMIDE ON PREVENTION OF POSTOPERATIVE NAUSEA AND VOMITING IN LAPAROSCOPIC CHOLECYSTECTOMY UNDER GENERAL ANESTHESIA
Gona A. M. Ali a and Aree H. R. Hama b
a Department of Surgery, College of Medicine, University of Sulaimani.
b Directorate of Health, Sulaimani.
Submitted: 23/2/2017; Accepted: 1/8/2017; Published: 15/8/2017
DOI Link: https://doi.org/10.17656/jsmc.10119
Postoperative nausea and vomiting is one of the most frequent complications of general anesthesia. The overall incidence of postoperative nausea and vomiting is currently estimated to be around 20 to 30% and in certain high-risk patients; this incidence may reach 70% .
The aim of the study is to compare the antiemetic efficacy of midazolam or metoclopramide in laparoscopic surgery under general anesthesia.
In this study 120 patients (ASA I–II) whom underwnet laparoscopic cholecystectomy in Sulaimani Teaching Hospital were evaluated as double-blinded randomized study, patients were allocated randomly to one of three main groups: Group 1 (n= 40) received midazolam (0.03 mg/kg) i.v as a premedication, Group 2 (n= 40) received metoclopramide (10 mg) i.v as a premedication and Group 3 (n= 40) received standard premedication. Anesthesia was standardized for all patients, follow up done for them up to 24 hrs. Data were interpreted by Chi-square test and Pearson’s test, using Statistical Package of Social Sciences Software (SPSS).
The incidence of postoperative nausea and vomiting was 20% with midazolam (P < 0.05), 35% with metoclopramide (P >0.05), and 57.5% with none of two drugs.
Midazolam is more effective than metoclopramide in preventing post-operative nausea and vomiting.
Post operative nausea and vomiting, Midazolam and Metoclopramide.
1. Cohen MM, Duncan PG, DeBoer DP, Tweed WA. The postoperative interview: assessing risk factors for nausea and vomiting. AnesthAnalg 1994; 78: 7–16.
2.Apfel CC, Laara E, Koivuranta M, Greim CA, Roewer N. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Anesthesiology 1999; 91: 693–700.
3. Ronald D.Miller, Roy F. Cucchiara, Edward D. Miller, J.Gerald Reves, Michael F. Roizen, and John J.Sacarese, (Anesthesia) fifth edition, United State of America, 2000,P 2013,2004-2009,2220.
4. Alan R. Aitkenhead, David J. Rowbotham, and Graham Smith (Textbook ofAnaesthesia) fourth edition, Spain, 2001, P 244-249,194.
5. Gold BS, Kitz DS, Lecky JH, Neuhaus JM. Unanticipated admission to the hospital following ambulatory surgery. JAMA 1989; 262: 3008–10.
6. Myles PS, Williams DL, Hendrata M, Anderson H, Weeks AM. Patient satisfaction after anaesthesia and surgery: results of a prospective survey of 10 811 patients. Br J Anaesth 2000; 84: 6–10.
7.Habib AS. Midazolam: an anti-emetic? Anaesthesia 2002; 57: 725.
8. Di Florio T. The use of midazolam for persistent postoperative nausea and vomiting. AnaesthIntens Care 1992; 20: 383-386.
9. Takada K., Murai T., Kanayama T., Koshikawa N. Effects of midazolam and flunitrazepam on the release of dopamine from rat striatum measured in vivo microdialysis. Br J Anaesth 1993; 70: 181-185.
10. Racke K, Schwore H, Kilbinger H. The pharmacology of 5-HT release from enterochromaffin cells. In: Reynolds WM, Andrews PLR, Davis CJ (Eds). Serotonin and the scientific basis of antiemetic therapy. Oxford Clinical Communications 1995; 84-89.
11. Heidari SM, Saryazdi H, Saghaei M: Effect of intravenous midazolam premedication on postoperative nausea and vomiting after cholecystectomy. ActaAnaesthesiol; Taiwan, 2004, 42:77-80.
12. Safavi MR, Honarmand A. Low dose intravenous midazolam for prevention of ponv, in lower abdominal surgery, Middle East J Anesthesiol. 2009 Feb; 20(1):75-81.
13. Sanjay O.P., Tauro DI: Midazolam: an effective antiemetic after cardiac surgery – a clinical trial. AnesthAnalg; 2004, 99:339-343.
14. JH Ha, KH Kwak, JW Seo, SH Lee, SS Park, Effectiveness of Ondansetron and Midazolam in the Prevention of PONV after Thyroidectomy. Korean Journal of Anesthesiology, 2007 Sep;53(3):344-349. Synapse.koreamed.org.
15. Henzi I, Walder B, Tramer MR. Metoclopramide in the prevention of postoperative nausea and vomiting: a quantitative systematic review of randomized, placebo controlled studies. Br J Anaesth 1999; 83: 761–71.
16. Piper SN, Triem JG, Maleck WH, Fent MT, Hüttner I, Boldt J. Placebo-controlled comparison of dolasetron and metoclopramide in preventing postoperative nausea and vomiting undergoing hysterectomy. Eur J Anaesthesiol 2001; 18: 251–6.
17. Eberhart LHJ, Morin AM, Felbinger TW, Falkner Y, Georgieff M, Seeling W. Results of a survey of anesthetistson postoperative nausea and vomiting (German). Anaesthesiol Intensivmed Notfallmed Schmerzther 1998; 33: 545–51.
18. Lerman J. Surgical and patient factors involved in postoperative nausea and vomiting. Br J Anaesth 1992; 69: 24S–32.
19. Grebenik CR, Allman C. Nausea and vomiting after cardiac surgery. Br J Anaesth 1996; 77: 356–9.
20. Koizumi Y, Matayoshi Y, Kondoh K, et al. Postoperative nausea and vomiting after open heart surgery. Masui 2002; 51: 638–41.
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