Tang Jun, Chen Xiaoguang, White Paul F, Wender Ronald H, Ma Hong, Sloninsky Alexander, Naruse Robert, Kariger Robert, Webb Tom, Zaentz Alan
University of Texas Southwestern Medical Center at Dallas, 75390, USA.
Anesthesiology. 2003 Feb;98(2):293-8. doi: 10.1097/00000542-200302000-00005.
Office-based surgery has become increasingly popular because of its cost-saving potential. However, the occurrence of postoperative nausea and vomiting (PONV) can delay patient discharge. Prophylaxis using a combination of antiemetic drugs has been suggested as an effective strategy for minimizing PONV. The authors designed this randomized, double-blinded, placebo-controlled study to assess the efficacy of ondansetron and dolasetron when administered in combination with droperidol and dexamethasone for routine antiemetic prophylaxis against PONV in the office-based surgery setting.
Following institutional review board approval, 135 consenting outpatients with American Society of Anesthesiologists physical status I-III who were undergoing superficial surgical procedures lasting 20-40 min were randomly assigned to one of three antiemetic treatment groups. Propofol was administered for induction of anesthesia, followed by 2-4% desflurane with 67% nitrous oxide in oxygen. Desflurane was subsequently adjusted to maintain a clinically adequate depth of anesthesia with an electroencephalographic Bispectral Index value between 50 and 60. All patients received 0.625 mg intravenous droperidol and 4 mg intravenous dexamethasone after induction of anesthesia. The study medication, containing normal saline (control), 12.5 mg intravenous dolasetron, or 4 mg intravenous ondansetron, was administered prior to the end of surgery. All patients received local anesthetics at the incisional site and 30 mg intravenous ketolorac to minimize postoperative pain. Recovery profiles, incidence of PONV, requirement for rescue antiemetic drugs, complete response rates, and patient satisfaction were assessed.
The recovery times to patient orientation, oral intake, ambulation, and actual discharge did not differ among the three groups. The incidence of PONV, nausea scores, and requirement for rescue antiemetics were also similar in all three groups during the 24-h study period. In addition, the complete response rates to the prophylactic antiemetics (96-98%) and percentages of very satisfied patients (93-98%) were equally high in all three groups. However, the antiemetic drug acquisition costs were US $2.50, $15.50, and $18.50 in the control, dolasetron, and ondansetron groups, respectively.
The addition of dolasetron (12.5 mg) or ondansetron (4 mg) failed to improve the antiemetic efficacy of droperidol (0.625 mg intravenous) and dexamethasone (4 mg intravenous) when they were used for routine prophylaxis in the office-based surgery setting.
由于具有潜在的成本节约优势，门诊手术越来越受欢迎。然而，术后恶心呕吐（PONV）的发生会延迟患者出院。使用联合止吐药物进行预防被认为是将PONV降至最低的有效策略。作者设计了这项随机、双盲、安慰剂对照研究，以评估昂丹司琼和多潘立酮与氟哌利多和地塞米松联合使用时，在门诊手术环境中对PONV进行常规止吐预防的疗效。
经机构审查委员会批准，135名自愿参与的美国麻醉医师协会身体状况I-III级、正在接受持续20-40分钟浅表外科手术的门诊患者被随机分配到三个止吐治疗组之一。使用丙泊酚诱导麻醉，随后使用2-4%地氟醚与67%氧化亚氮和氧气混合。随后调整地氟醚以维持临床上足够的麻醉深度，脑电双频谱指数值在50至60之间。所有患者在麻醉诱导后接受0.625mg静脉注射氟哌利多和4mg静脉注射地塞米松。研究药物，包括生理盐水（对照组）、12.5mg静脉注射多潘立酮或4mg静脉注射昂丹司琼，在手术结束前给药。所有患者在切口部位接受局部麻醉药，并静脉注射30mg酮咯酸以尽量减少术后疼痛。评估恢复情况、PONV发生率、抢救性止吐药物需求、完全缓解率和患者满意度。
三组患者在定向、经口进食、行走和实际出院方面的恢复时间没有差异。在24小时研究期间，三组患者的PONV发生率、恶心评分和抢救性止吐药物需求也相似。此外，三组患者对预防性止吐药物的完全缓解率（96-98%）和非常满意患者的百分比（93-98%）同样高。然而，对照组、多潘立酮组和昂丹司琼组的止吐药物购置成本分别为2.50美元、15.50美元和18.50美元。
在门诊手术环境中进行常规预防时，添加12.5mg多潘立酮或4mg昂丹司琼并不能提高0.625mg静脉注射氟哌利多和4mg静脉注射地塞米松的止吐效果。
