Eberhart L H, Lindenthal M, Seeling W, Gäckle H, Georgieff M
Universitätsklinik für Anästhesiologie, Universität Ulm.
Anasthesiol Intensivmed Notfallmed Schmerzther. 1999 Jun;34(6):345-9. doi: 10.1055/s-1999-8742.
Both, droperidol and the new 5-HT3-antagonist (e.g. dolasetron) are effective drugs in the prevention of postoperative nausea and vomiting (PONV). It was the aim of this prospective double blind placebo controlled study to determine the efficacy of low-dose droperidol, dolasetron, and a combination of both drugs in the prevention of PONV after extracapsular cataract extraction.
148 inpatients undergoing cataract surgery were stratified according to gender and then randomised to receive one of four antiemetic regimens: placebo, droperiodol (10 micrograms x kg-1), dolasetron (12.5 mg), or the combination of both drugs (10 micrograms x kg-1 + 12.5 mg). The drugs were administered intravenously 5-10 minutes before the end of anaesthesia. General anaesthesia and the perioperative management of the patients were standardised: benzodiazepine premedication, induction with etomidate, alfentanil and mivacurium. Maintenance using desflurane in N2O/O2, and a continuous infusion of mivacurium was used. Postoperative analgesia (diclofenac or paracetamol) and antiemetic rescue medication (dimenhydrinate and metoclopramide) was standardised. Nausea, episodes of vomiting, retching and the need for additional antiemetics were recorded for 24-hours. The severity of PONV was categorised using a standardised scoring algorithm. The main aim of the study was the number of patients who stayed completely free from PONV.
There were no differences between the two groups with regard to biometric data, type of surgery, and distribution of risk factors for developing PONV. In all three treatment groups significantly less patients suffered from PONV (placebo: 66%; droperidol: 89%, dolasetron: 92%, combination: 89%; p = 0.011). Furthermore, the severity of PONV was reduced (p = 0.012).
Low-dose droperidol and dolasetron are equally effective to reduce the incidence of PONV after cataract surgery under general anaesthesia. The combination of both drugs revealed no additional effect.
氟哌利多和新型5-羟色胺3拮抗剂（如多潘立酮）都是预防术后恶心和呕吐（PONV）的有效药物。这项前瞻性双盲安慰剂对照研究的目的是确定低剂量氟哌利多、多潘立酮以及两种药物联合使用在预防囊外白内障摘除术后PONV方面的疗效。
148例接受白内障手术的住院患者按性别分层，然后随机接受四种止吐方案之一：安慰剂、氟哌利多（10微克/千克）、多潘立酮（12.5毫克）或两种药物联合使用（10微克/千克 + 12.5毫克）。在麻醉结束前5 - 10分钟静脉给药。患者的全身麻醉和围手术期管理标准化：苯二氮卓类药物术前用药，依托咪酯、阿芬太尼和米库氯铵诱导麻醉。使用地氟醚在N2O/O2中维持麻醉，并持续输注米库氯铵。术后镇痛（双氯芬酸或对乙酰氨基酚）和止吐急救药物（茶苯海明和甲氧氯普胺）标准化。记录24小时内的恶心、呕吐发作、干呕情况以及使用额外止吐药的需求。使用标准化评分算法对PONV的严重程度进行分类。该研究的主要目的是完全没有PONV的患者数量。
两组在生物统计学数据、手术类型和发生PONV的危险因素分布方面没有差异。在所有三个治疗组中，发生PONV的患者明显较少（安慰剂组：66%；氟哌利多组：89%，多潘立酮组：92%，联合用药组：89%；p = 0.011）。此外，PONV的严重程度降低了（p = 0.012）。
低剂量氟哌利多和多潘立酮在降低全身麻醉下白内障手术后PONV的发生率方面同样有效。两种药物联合使用没有显示出额外的效果。
