Fujii Y, Tanaka H, Toyooka H
Department of Anaesthesiology, Toride Kyodo General Hospital, Ibaraki, Japan.
Acta Anaesthesiol Scand. 1998 Oct;42(9):1038-42. doi: 10.1111/j.1399-6576.1998.tb05373.x.
Dexamethasone decreases chemotherapy-induced emesis when added to an antiemetic regimen. This study was undertaken to evaluate the efficacy of granisetron-dexamethasone combination for the prevention of postoperative nausea and vomiting (PONV) in female patients undergoing general anaesthesia for breast surgery.
In a randomized, double-blind manner, 135 ASA I patients, aged 40-65 years, were assigned to receive placebo (saline), granisetron 40 micrograms.kg-1 or granisetron 40 micrograms.kg-1 plus dexamethasone 8 mg i.v. (n = 45 of each) immediately before the induction of anaesthesia. A standard general anaesthetic technique and postoperative analgesia were used. The PONV and safety assessments were performed continuously during the first 3 h (0-3 h) and the next 21 h (3-24 h) after anaesthesia.
A complete response, defined as no PONV and no administration of rescue antiemetic medication, during 0-3 h after anaesthesia was 51%, 82% and 96% in patients who had received placebo, granisetron and granisetron-dexamethasone combination, respectively; the corresponding incidence during 3-24 h after anaesthesia was 56%, 84% and 98% (P < 0.05; overall Fisher's exact probability test). No clinically important adverse events were observed in any of the groups.
Prophylactic use of granisetron-dexamethasone combination is more effective than granisetron alone for the prevention of PONV after breast surgery.
地塞米松添加到止吐方案中可减少化疗引起的呕吐。本研究旨在评估格拉司琼 - 地塞米松联合用药对接受乳房手术全身麻醉的女性患者预防术后恶心和呕吐（PONV）的疗效。
采用随机、双盲方式，将135例年龄在40 - 65岁的ASA I级患者在麻醉诱导前即刻分为三组，每组45例，分别接受安慰剂（生理盐水）、40微克·千克⁻¹格拉司琼或40微克·千克⁻¹格拉司琼加8毫克静脉注射地塞米松。采用标准的全身麻醉技术和术后镇痛。在麻醉后的前3小时（0 - 3小时）和接下来的21小时（3 - 24小时）连续进行PONV和安全性评估。
麻醉后0 - 3小时，接受安慰剂、格拉司琼和格拉司琼 - 地塞米松联合用药的患者中，完全缓解（定义为无PONV且未使用抢救性止吐药物）的比例分别为51%、82%和96%；麻醉后3 - 24小时的相应发生率分别为56%、84%和98%（P < 0.05；总体Fisher确切概率检验）。所有组均未观察到具有临床意义的不良事件。
预防性使用格拉司琼 - 地塞米松联合用药在预防乳房手术后的PONV方面比单独使用格拉司琼更有效。
