Page 42 - World Journal of Laparoscopic Surgery

Reduction of Vomiting after Laparoscopic Cholecystectomy
and vomiting can improve patient satisfaction with medical and aged over 50 and under 18, patients with a health status of 3, 4, 5 the
anesthetic services and promote the level of activities and the American Association of Anesthesiologists, patients with regional
patient’s faster recovery. 6 anesthesia cholecystectomy, patients with any systemic disease,
Different factors in the incidence of post-surgical nausea and such as diabetes, asthma, cardiovascular disease, gastroesophageal
vomiting play a role in spinal anesthesia, the most important factor reflux, severe obesity, pregnancy, lactation, liver and kidney
being the increased stimulation of vagus due to sympathetic diseases, neuromuscular diseases, psychiatric disorders, alcohol
inhibition. Other factors, such as hypotension (systolic blood addicts and drug and smoker, and acute cholecystitis.
pressure less than 80 mm Hg), block-level higher than thoracic fifth This study is double-blind. For the blinding of drugs and
space, adding substances such as vasoconstrictors, neostigmine, placebo, they are packaged by a pharmacist in unnamed packages
and opioids to the anesthetic, increase the chance of nausea and and encoded and packaged into the operating room. After
vomiting. Reduced blood pressure causes brain stem cell ischemia, completing the design and measuring the indicators before the
which leads to stimulation of the vomiting center in the brain stem. patient data analysis, the codes are delivered from the pharmacist
Also, hypotension is associated with ischemia of the intestines and and the case and control groups are identified.
the release of nausea-like substances, such as serotonin. 2 After insertion of the patient into the operating room, venous
Several methods and drugs, including metoclopramide, access of the patient had the fluid infusion, and crystalloid infusion
droperidol, a specific 5-HT antagonist, propofol, and dexamethasone, (Ringer’s serum) started at 500 cc and vital signs were monitored.
are used to treat this condition. The most commonly used General anesthesia was induced and patients were divided into
drug is metoclopramide, which is characterized by the risk of three groups: at the same time as an anti-nausea drug, ondansetron
extrapyramidal symptoms and complications, such as drowsiness, 4 mg (Tehran Chemistry Company) was administered intravenously
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dizziness, and headache. Therefore, proper treatment achievement and placebo capsule an hour before the operation. In another
is one of the concerns in this regard, so that research in reducing group, an 80-mg aprepitant capsule from Tehran Chemistry
postoperative nausea and vomiting focuses on low-price methods Company received an hour before the operation with placebo
and drugs. The drug should have the greatest effect and duration ampulla during operation and in the third group, an 80-mg capsule
and the least complication. 6 of aprepitant 1 hour before the operation and 4 mg ondansetron
The aprepitant is a long-acting agonist of neurokinin-1 (NK1), was given during the operation.
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whose half-life is 9–12 hours. The neurokinin receptor 1 is known The patient was monitored for at least 30 minutes in the
to be nausea-like as a receptor with high effect in both acute and recovery room and then was delivered to the surgical ward. The
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chronic forms. This drug has been approved by FDA for nausea severity of nausea and vomiting of patients at 6 and 24 hours after
prophylaxis induced by chemotherapy. This oral medication is the operation as early and late symptoms using visual analog
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known as an effective drug for opioid nausea. On the other hand, scale (VAS) criteria was recorded in the questionnaire. Nausea
it has no sedative effect and its use in obese and apnea patients is and vomiting were measured based on VAS criteria. A 100 mm
quite safe during surgery and anesthesia. 10 graduated line, the first of which without nausea, and the end of
The other drugs include serotonin antagonists, such as it is unbearable nausea. The occurrence of nausea and vomiting
ondansetron and dolasetron, which have a good effect on nausea is collected through a patient’s inquiry. The need for antiemetic
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and vomiting. Ondansetron complications are headache, stomach medication is questioned by the nurse. Patient information is
upset, dizziness, flushing of the injection site, and arrhythmia. 11 categorized in separate tables and analyzed by SPSS software.
Another risk factors for postoperative nausea and vomiting
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are laparoscopic. Laparoscopy is used to diagnose and treat results
many diseases. Pneumoperitoneum, during laparoscopy, can
stimulate the vagus nerve and increase the chance of nausea and The mean age of the patients was 39.14 with a standard deviation
vomiting. Postoperative nausea and vomiting cause, discharge of 7.78 years (Fig. 1). The highest age in this study was 50 years and
delay, dehydration, wound dehiscence, pulmonary aspiration, the lowest 21 years. The mean severity of nausea and vomiting at
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patient dissatisfaction, and increased costs. Regarding the high
prevalence of laparoscopic cholecystectomy and postoperative
nausea and vomiting, in our study, we compared the effect of
aprepitant, ondansetron, and combination of ondansetron and
aprepitant, on postoperative nausea and vomiting, to introduce a
regimen that is safe and low cost.

MAterIAls And Methods
After approving the plan and performing the necessary
coordination, the study was performed as a double-blind clinical
trial after receiving written consent from patients. A total of 90
patients which were candidate for laparoscopic cholecystectomy
under general anesthesia were admitted to the hospital. Inclusion
criteria for the study include all patients are women aged 18–50
years, and the American Association of Anesthesiologists has a
health level of 1 and 2, and at least two APFEL criteria (including
female gender, non-smoker, having a history of PONV, and use of
100 mcg fentanyl or equivalent). Exclusion criteria include a woman Fig. 1: Box plot of age distribution in groups

40 World Journal of Laparoscopic Surgery, Volume 14 Issue 1 (January–April 2021)