Estudo comparativo de antieméticos e suas associações, na prevenção de náuseas e vômitos pós-operatórios, em pacientes submetidas a procedimentos cirúrgicos ginecológicos
Comparative study of anti-emetics and their association, in the prevention of postoperative nausea and vomiting in patients undergoing gynecologic surgeries
Taylor Brandão Schnaider; Antônio Mauro Vieira; Antônio Carlos Aguiar Brandão
Resumo
Palavras-chave
Abstract
BACKGROUND AND OBJECTIVES: Prophylaxis of postoperative nausea and vomiting has been the subject of several studies. The objective of the present study was to compare anti-emetics, and their association, in the prevention of postoperative nausea and vomiting.
METHODS: Seventy patients, ASA I and II, underwent epidural block associated with general anesthesia for gynecologic surgeries. Patients in the Metochlopramide Group (MG) received 20 mg of the drug; the Dexamethasone Group (DeG) received 8 mg; the Droperidol Group (DrG) received 1.25 mg; the Ondansetron Group (OG) received 8 mg; the Dexamethasone-Ondansetron Group (DeOG) received 8 mg and 4 mg, respectively; the Droperidol-Ondansetron Group (DrOG) received 1.25 mg and 4 mg, respectively; the Dexamethasone-Droperidol-Ondansetron Group (DeDrOG) received 8 mg, 0.625 mg, and 4 mg. The presence of nausea and vomiting was evaluated at 6, 12, 24, and 36 hours after the end of the surgery.
RESULTS: The total incidence of episodes of nausea per group is as follows: 4 in DeDrOG, 6 in OG, 6 in DrOG, 11 in DeG, 11 in DeOG, 18 in MG, and 22 in DrG. The Chi-square and Fisher exact tests indicated statistically significant differences between DrG and DeG, DOG, DrOG, DeOG, and DeDrOG; between MG and OG, DrOG, and DeDrOG; and between DeOG and DeDrOG. And the incidence of vomiting was: 3 in OG, 3 in DeDrOG, 6 in DrOG, 7 in DeG, 7 in DeOG, and 10 in DrG, and 13 in G. There was a statistically significant difference between DrG and OG and DeDrOG; and between MG and OG and DeDrOG.
CONCLUSIONS: The association dexamethasone-droperidol-ondansetron and ondansetron alone were more effective in the prophylaxis of nausea and vomiting.
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References
Watcha MF, White PF. Postoperative nausea and vomiting: Its etiology, treatment, and prevention. Anesthesiology. 1992;77:164-184.
Lages N, Fonseca C, Neves A. Náuseas e vômitos no pós-operatório: uma revisão do "pequeno-grande" problema. Rev Bras Anestesiol. 2005;55:575-585.
Kenny GN. Risck factors for postoperative nausea and vomiting. Anaesthesia. 1994;49(^sSuppl):6-10.
Lerman J. Surgical and patient factor envolved in postoperative nausea and vomiting. Br J Anaesth. 1992;69:24S-32S.
Gan TJ. Postoperative nausea and vomiting Can it be eliminated?. JAMA. 2002;287:1233-1236.
Yuen HK, Chiu JW. Multimodal antiemetic therapy and emetic risck profiling. Ann Acad Med Singapore. 2005;34:196-205.
Abreu MP. Náuseas e vômitos Antieméticos. Anestesia ambulatorial. 2001:339-357.
Ganem EM, Fabris P, Moro MZ. Eficácia do ondansetron e da alizaprida na prevenção de náuseas e vômitos em laparoscopia ginecológica. Rev Bras Anestesiol. 2001;51:401-406.
Koivuranta M, Ala-Kokko TI, Jokela R. Comparison of ondansetron and tropisetron combined with droperidol for the prevention of emesis in women with a history of postoperative nausea and vomiting. Eur J Anaesthesiol. 1999;16:390-395.
Carroll NV, Miederhoff P, Cox FM. Postoperative nausea and vomiting after discharge from outpatient surgery centers. Anesth Analg. 1995;80:903-909.
Contreras-Domínguez V, Carbonell-Bellolio P. Estudio clínico comparativo, randomizado y doble ciego entre droperidol, metoclopramida, tropisetrón, granisetrón e dexametasona para profilaxis antiemética en apendicectomia. Rev Argent Anestesiol. 2007;65:107-116.
Zhang Y, Luo Z, White PF. A model for evaluating droperidol´s effect on the median QTc interval. Anesth Analg. 2004;98:1330-1335.
Nuttall GA, Eckerman KM, Jacob KA. Does low-dose droperidol administration increase the risk of drug-induced QT prolongation and torsade de pointes in the general surgical population?. Anesthesiology. 2007;107:531-536.
Contreras-Domínguez V, Carbonell-Bellolio P. Profilaxia antiemética em cirurgia de abdome agudo: Estudo comparativo entre droperidol, metoclopramida, tropisetron, granisetron e dexametasona. Rev Bras Anestesiol. 2008;58:35-44.
White PF, Song D, Abrão J. Effect of low-dose droperidol on the QT interval during and after general anesthesia: a placebo-controlled study. Anesthesiology. 2005;102:1101-1105.
Leksowski K, Peryga P, Szyca R. Ondansetron, metoclopramide, dexamethasone, and their combinations compared for the prevention of postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy: a prospective randomized study. Surg Endosc. 2006;20:878-882.
Elhakim M, Nafie M, Mahmoud K. Dexamethasone 8 mg in combination with ondansetron 4 mg appears to be the optimaldose for the prevention of nausea and vomiting after laparoscopic cholecystectomy. Can J Anaesth. 2002;49:922-926.
Abreu MP, Vieira JL, Silva IF. Eficácia do ondansetron, metoclopramida, droperidol e dexametasona na prevenção de náuseas e vômitos após laparoscopia ginecológica em regime ambulatorial: Estudo comparativo. Rev Bras Anestesiol. 2006;56:8-15.
Domino KB, Anderson EA, Polissar NL. Comparative efficacy and safety of ondansetron, droperidol, and metoclopramide for preventing postoperative nausea and vomiting: a meta-analysis. Anesth Analg. 1999;88:1370-1379.
Schmidt A, Bagatini A. Náuseas e vômitos pós-operatório: fisiopatologia, profilaxia e tratamento. Rev Bras Anestesiol. 1997;47:326-334.
Fugii Y, Saitoh Y, Tanaka H. Granisetron/dexametasone combination for reducing nausea and vomiting during and after spinal anesthesia for cesarean section. Anesth Analg. 1999;88:1346-1350.
Fugii Y, Saitoh Y, Tanaka H. Prophylatic therapy with combined granisetron and dexametasone for the prevention of post-operative vomiting in children. Eur J Anaesthesiol. 1999;16:376-379.
Mckenzie R, Uy NT, Riley TJ. Droperidol/ondansetron combinations controls nausea and vomiting after tubal banding. Anesth Analg. 1996;83:1218-1222.
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