Page 31 - World Journal of Laparoscopic Surgery

Comparison of Drugs and Intravenous Crystalloid in Reduction of Postoperative Nausea and Vomiting after Lap Surgery
World Journal of Laparoscopic Surgery, January-April 2008;1(1):29-34
Comparison of Drugs and Intravenous

Crystalloid in Reduction of Postoperative

Nausea and Vomiting after Laparoscopic Surgery

Alaa H Ali

Department of Anesthesiology, Medical city, Iraq, Baghdad

Abstract care, and potential hospital admission—all factors that may
Background: Nausea and vomiting are frequent after general anesthesia increase total health care costs. Patients report that avoidance
,the most important causes of morbidity after anesthesia and surgery of PONV is of greater concern than avoidance of postoperative
are postoperative nausea and vomiting. pain. The optimal approach to PONV management remains
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unclear to many clinicians. Guidelines for prevention and
Methods: A comparative analysis of published articles was done to
determine the relative efficacy and safety of ondansetron, droperidol, treatment of PONV based on data from systematic reviews of
6,7
metoclopramide, dexamethasone, and intravenous crystalloid fluid for randomized trials have been published. Patients incur a fluid
the prevention of postoperative nausea and vomiting. I performed a deficit by mandatory preoperative fasting. Guided intravenous
8,9
literature search of English references using both the MEDLINE database fluid therapy improves outcomes in major surgery. It has
and a manual search. Double-blinded, randomized, controlled trials been suggested that relative hypovolemia may be a factor in
comparing the effect of these agents in reduction or prevention of such adverse outcomes after surgery and that preoperative
postoperative nausea and vomiting. administration of intravenous fluids reduces their incidence. 10
Gan and colleagues showed an earlier return to bowel function,
Results: A total of 60 studies were identified, of which 6 were excluded
for methodological concerns. For each comparison of drugs, ondansetron decreased length of hospital stay and a reduction in PONV by
(P < 0.001), droperidol (P < 0.001) were more effective than using esophageal Doppler with goal-directed therapy aimed at
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metoclopramide in preventing vomiting. We conclude that ondansetron maintaining stroke volume. While they studied a major surgery
and droperidol are more effective than metoclopramide in reducing group with expected blood loss in excess of 500 ml, their work
postoperative nausea and vomiting. The incidence of vomiting was supports our hypothesis that reduced bowel mucosal perfusion
reduced in the intravenous administration of crystalloid 30 mg/kg in may be a factor in PONV. I, therefore performed a meta-analysis
healthy adults (P = 0.001) and for dexamethasone is (P < 0.03). of published, randomized, controlled trials of prophylactic
antiemetic therapy to determine the relative efficacy and safety
Conclusion: In summary, both ondansetron and droperidol were more of ondansetron, metoclopramide, droperidol, intravenous
effective than metoclopramide, intravenous crystalloid fluid and
dexamethasone in preventing postoperative vomiting. crystalloid fluid and dexamethasone for preventing PONV.

Keywords: Laparoscopy postoperative nausea and vomiting,
droperidol, metoclopramide, ondansetron, IV crystalloid. METHODS

An initial list of published studies was obtained by searching
INTRODUCTION
the MEDLINE database from (1996 to 2007) using the terms
Postoperative nausea and vomiting (PONV) remains one of the (MeSH as well as text search) “prevention,” “postoperative
most common postoperative complications and is experienced complications,” “nausea and vomiting” separately for
1
by up to 70% of patients (Hofer and colleagues). It is a limiting “ondansetron,” “droperidol,” “metoclopramide, dexamethasone,
factor in the early discharge of ambulatory surgery patients and intravenous crystalloid fluid.” The list was expanded by a
and is a leading cause of unanticipated hospital admission. 2,3 manual search of table of contents in English anesthesiology
There is still controversy concerning the best approach to journals and reference lists from all articles, review articles,
4
managing postoperative nausea and vomiting (PONV). PONV correspondence, and abstracts related to PONV. Only English-
can lead to increased recovery room time, expanded nursing language references were included.

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