Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942005000400003
Brazilian Journal of Anesthesiology
Scientific Article

Dexametasona comparada à metoclopramida na profilaxia de vômitos pós-operatórios em crianças submetidas a procedimentos cirúrgicos ambulatoriais

Dexamethasone compared to metoclopramide in the prophylaxis of emesis in children undergoing ambulatory surgical procedures

Antonio Bedin; Mauro de Souza Leite Pinho; Cladir Terezinha Zanotelli; Ângela Sílvia Caldart; Jurandir Coan Turazzi; Renato Almeida Couto de Castro

http://dx.doi.org/10.1590/S0034-70942005000400003 Braz J Anesthesiol, vol.55, n4, p.387-396, 2005
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Resumo

JUSTIFICATIVA E OBJETIVOS: O vômito pós-operatório é uma complicação comum e desagradável. Porém, atualmente modelos matemáticos tais como número necessário para tratar (NNT) e redução do risco relativo (RRR) têm sido úteis para a decisão de que medicação utilizar para a profilaxia. O objetivo deste estudo foi verificar se a dexametasona, comparada à metoclopramida, reduz a incidência de vômitos, quando administrada por via venosa em crianças anestesiadas com sevoflurano em cirurgias pediátricas ambulatoriais. MÉTODO: Participaram do estudo 237 crianças, do sexo masculino, com idade entre 11 meses e 12 anos, estado físico ASA I e II, submetidas à herniorrafia inguinal. Como medicação pré-anestésica foi utilizado midazolam por via oral. Para a indução e manutenção da anestesia foram utilizados sevoflurano, óxido nitroso e fentanil (1 µg.kg-1). Os pacientes foram divididos em grupo D (n = 118) dexametasona (150 µg.kg-1) por via venosa na indução e grupo M (n = 119) metoclopramida (150 µg.kg-1) na indução. Foram analisadas as incidências de vômitos nas primeiras 4 horas de pós-operatório (PO), entre 4 horas e 24 horas de PO, o NNT de ambas as medicações utilizadas e a RRR da dexametasona em relação à metoclopramida. RESULTADOS: A incidência de vômitos foi 9,32% no grupo D e 33,61% no grupo M durante as primeiras 4 horas de PO e 1,69% com a dexametasona e de 3,36% com a metoclopramida entre 4 e 24 horas de PO. O RRR foi 72% da dexametasona em relação à metoclopramida nas primeiras 4 horas. O NNT da dexametasona foi 3,25 e o da metoclopramida foi 15,66. CONCLUSÕES: A dexametasona reduz, de forma mais eficiente que a metoclopramida, a incidência de vômitos quando utilizada durante a indução de anestesia com sevoflurano associado ao óxido nitroso e fentanil.

Palavras-chave

ANTIEMÉTICOS, ANTIEMÉTICOS, CIRURGIA, COMPLICAÇÕES, COMPLICAÇÕES

Abstract

BACKGROUND AND OBJECTIVES: Postoperative vomiting is a common and unpleasant complication. Currently, however, mathematical models, such as number necessary to treat (NNT) and relative risk reduction (RRR), have been useful in the decision of which medication to use for prophylaxis. This study aimed at verifying whether dexamethasone, as compared to metoclopramide, decreases the incidence of vomiting when intravenously administered to children anesthetized with sevoflurane for ambulatory pediatric surgeries. METHODS: Two hundred and thirty seven male children, aged 11 months to 12 years, physical status ASA I and II, undergoing hernia repair were included in this study. They were premedicated with oral midazolam. Anesthesia was induced and maintained with sevoflurane, nitrous oxide, and 1 µg.kg-1 fentanyl. Patients were divided in two groups: group D patients (n = 118) were given 150 µg.kg-1 dexamethasone at induction while group M (n = 119) received 150 µg.kg-1 metoclopramide at induction. The following parameters were evaluated: incidence of vomiting in the first 4 postoperative hours (PO), incidence of vomiting between 4 and 24 PO hours, NNT of both medications and RRR of dexamethasone as compared to metoclopramide. RESULTS: The incidence of vomiting was 9.32% for group D and 33.61% for group M during the first 4 PO hours, and 1.69% with dexamethasone and 3.36% with metoclopramide between 4 and 24 PO hours. RRR of dexamethasone related to metoclopramide in the first 4 hours was 72%. The number necessary to treat (NNT) for dexamethasone was 3.25 and for metoclopramide it was 15.66. CONCLUSIONS: Dexamethasone is more effective than metoclopramide in decreasing the incidence of vomiting when used during anesthetic induction with sevoflurane associated to nitrous oxide and fentanyl.

Keywords

ANTIEMETICS, ANTIEMETICS, COMPLICATIONS, COMPLICATIONS, SURGERY

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