Kizilcik Nurcan, Bilgen Sevgi, Menda Ferdi, Türe Hatice, Aydın Bilgehan, Kaspar Elif Cigdem, Koner Ozge
Department of Anesthesiology and Reanimation, Yeditepe University School of Medicine, Istanbul, Turkey.
Department of Aesthetic and Plastic Surgery, Yeditepe University School of Medicine, Istanbul, Turkey.
Aesthetic Plast Surg. 2017 Feb;41(1):204-210. doi: 10.1007/s00266-016-0772-0. Epub 2016 Dec 30.
Postoperative Nausea and Vomiting is one of the most common problems after implementation of general anesthesia. The incidence can reach 80% in high-risk patients, depending on the type of surgery. In our study, we aimed to compare dexamethasone-dimenhydrinate and dexamethasone-ondansetron combinations in prevention of nausea and vomiting in postoperative patients.
Sixty 18-65-year-olds ASAI-II females who underwent rhinoplasty were included in the study. Patients were randomly included in two groups: Dexamethasone-dimenhydrinate group (group DD) and dexamethasone-ondansetron group (group DO). All patients received dexamethasone 8 mg iv after endotracheal intubation. Anesthesia continuation was established with sevoflurane, air-oxygen mixture and remifentanil infusion. At the 30th minute of the operation, group DO received ondansetron 4 mg iv and group DD received dimenhydrinate 1 mg/kg iv. For postoperative analgesia tramadol (1.5 mg/kg) iv, tenoksikam (20 mg) and afterward for postoperative patient-controlled tramadol was used. In the postoperative recovery room, nausea and vomiting were evaluated at the 30th, 60th, 120th minutes and at the end of 24 h. Total amount of tramadol was recorded. All results were statistically evaluated.
Demographics and Apfel risk scores of both groups were similar. Surgical operation duration (p = 0.038) and total preoperative remifentanil consumption were higher in group DD (p = 0.006). In group DO, nausea at 30 and 60 min (p = 0.001, p = 0.007), retching at 30 and 60 min (p = 0.002, p = 0.006) were higher than group DD. The additional antiemetic need in group DO was significantly higher at 30 min (p = 0.001). Postoperative analgesic consumption was similar in both groups.
Our study revealed that dexamethasone-dimenhydrinate combination was more effective than dexamethasone-ondansetron in prevention of nausea and vomiting after rhinoplasty operations.
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术后恶心呕吐是全身麻醉实施后最常见的问题之一。根据手术类型，高危患者的发生率可达80%。在我们的研究中，我们旨在比较地塞米松 - 茶苯海明和地塞米松 - 昂丹司琼联合用药在预防术后患者恶心呕吐方面的效果。
本研究纳入了60名年龄在18 - 65岁之间、美国麻醉医师协会（ASA）分级为I - II级的接受鼻整形手术的女性患者。患者被随机分为两组：地塞米松 - 茶苯海明组（DD组）和地塞米松 - 昂丹司琼组（DO组）。所有患者在气管插管后静脉注射8毫克地塞米松。采用七氟醚、空气 - 氧气混合气体和瑞芬太尼输注维持麻醉。在手术第30分钟时，DO组静脉注射4毫克昂丹司琼，DD组静脉注射1毫克/千克茶苯海明。术后镇痛采用静脉注射曲马多（1.5毫克/千克）、替诺昔康（二十毫克），随后采用术后患者自控曲马多镇痛。在术后恢复室，于第30、60、120分钟及24小时末评估恶心和呕吐情况。记录曲马多的总用量。所有结果进行统计学评估。
两组患者的人口统计学数据和阿佩尔（Apfel）风险评分相似。DD组的手术操作时间（p = 0.038）和术前瑞芬太尼总用量更高（p = 0.006）。DO组在第30和60分钟时的恶心发生率（p = 0.001，p = 0.007）以及第30和60分钟时的干呕发生率（p = 0.002，p = 0.006）均高于DD组。DO组在第30分钟时额外使用止吐药的需求显著更高（p = 0.001）。两组术后镇痛药物的用量相似。
我们的研究表明，在预防鼻整形手术后的恶心呕吐方面，地塞米松 - 茶苯海明联合用药比地塞米松 - 昂丹司琼更有效。
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