Prevenção de Náuseas e Vômitos com Metoclopramida em
Pacientes Submetidos a Curetagem Uterina sob
Anestesia Geral

Neuber Martins Fonseca; Rhafa Cristina Garcia de Paula Cardoso

Scientific Article

Prevenção de Náuseas e Vômitos com Metoclopramida em Pacientes Submetidos a Curetagem Uterina sob Anestesia Geral

Nausea and Vomiting Prevention with Metoclopramide in Patients Submitted to Uterine Curettage under General Anesthesia

Neuber Martins Fonseca, Rhafa Cristina Garcia de Paula Cardoso

Braz J Anesthesiol, vol.51, n2, p.105-111, 2001

PDF

Downloads: 0

Resumo

Justificativa e Objetivos - Náusea e/ou vômitos pós-operatórios são as manifestações mais comuns de morbidade associadas à anestesia. O etomidato promove alto índice de náuseas e vômitos (30 a 40%) e, apesar disto, continua sendo muito utilizado, dadas as suas qualidades hipnóticas. O propofol tem mostrado efeito antiemético em baixas concentrações. A associação de medicamentos para reduzir os efeitos adversos é conhecida. O presente estudo avalia a associação de metoclopramida com etomidato ou propofol em procedimento de curta duração na profilaxia pós-operatória de náusea e vômito. Método - Foram avaliadas 40 pacientes, com idades entre 16 e 39 anos, peso de 50 a 75 kg, estado físico ASA I, submetidas à curetagem uterina pós-aborto. A anestesia foi realizada com midazolam (0,05 mg.kg-1), alfentanil (10 a 30 g.kg-1) precedida de infusão venosa de metroclopramida (10 mg) ou solução fisiológica (2 ml) 5 minutos antes da anestesia. Propofol (2 mg.kg-1) ou etomidato (0,2 mg.kg-1) foi administrado por distribuição aleatória dos 40 pacientes em 4 grupos: I - 10 pacientes com etomidato e metroclopramida. II - 10 pacientes com etomidato e solução fisiológica, III - 10 pacientes com propofol e metoclopramida. IV - 10 pacientes com propofol e solução fisiológica. A avaliação pós-anestésica foi realizada nos momentos do despertar, 1 h, 3 h, 6 h, 12 h e 24 h após a anestesia, pelo anestesiologista que realizou o procedimento e que desconhecia o grupo nos momentos estudados. Resultados - Ocorreu maior índice de náuseas e/ou vômitos no grupo II. Observou-se queda significante da pressão arterial sistólica nos grupos I, II e IV em relação aos valores iniciais. Conclusões - O etomidato foi importante fator de náusea e vomito e a metoclopramida mostrou-se eficiente na sua prevenção.

Palavras-chave

ANESTESIA, Geral: venosa; COMPLICAÇÕES: náuseas, vômitos; HIPNÓTICOS: etomidato, propofol

Abstract

Background and Objectives - Postoperative nausea and vomiting are the most common anesthesia-related morbidities. Etomidate has a high incidence of nausea and vomiting (30 to 40%), and nevertheless, is still being used, due to its hypnotic properties. Propofol has shown an antiemetic effect in low concentrations. The association of medications to reduce adverse effects is well known. This study aimed at evaluating the association of metoclopramide with etomidate or propofol in short procedures for postoperative nausea and vomiting prophylaxis. Methods - Participated in this study 40 female patients aged 16 to 39 years, weighing 50 to 75 kg, physical status ASA I, submitted to post-abortion curettage. Anesthesia was induced with midazolam (0.05 mg.kg-1) and alfentanil (10 to 30 g.kg-1) preceded by intravenous metoclopramide (10 mg) or saline (2 ml) 5 minutes before anesthesia. Propofol (2 mg.kg-1) or etomidate (0.2 mg.kg-1) were randomly administered to the 40 patients divided into 4 groups: I - 10 patients with etomidate and metoclopramide. II - 10 patients with etomidate and saline. III - 10 patients with propofol and metoclopramide. IV - 10 patients with propofol and saline. Postanesthetic evaluation, was performed at emergence, 1 h, 3 h, 6 h, 12 h, 24 h, after anesthesia by an anesthesiologist blinded to the study group allocation. Results - Anthropomorphic data were homogeneous within groups. There has been a greater incidence of nausea and vomiting in group II. A significant decrease in systolic blood pressure was observed in groups I, II and IV as compared to baseline. Conclusions - Etomidate was an important nausea and vomiting factor and metoclopramide was effective in preventing them.

Keywords

ANESTHESIA, General: venous; COMPLICATIONS: nausea, vomiting; HIPNOTHICS: etomidate, propofol

Referencias

01. Watcha MF, White PF - Postoperative nausea and vomiting. Its etiology, treatment and prevention. Anesthesiology, 1992;77: 162-184.

02. Domino KB, Anderson EA, Polissar NL et al - Comparative efficacy and safety of ondansetron, droperidol, and metoclopramide for preventing postoperative nausea and vomiting: a meta-analysis. Anesth Analg, 1999;88:1370-1379.

03. Andrews PL - Physiology of nausea and vomiting. Br J Anaesth, 1992;69:2S-19S.

04. Palazzo MG, Strunin L - Anaesthesia and emesis I: etiology. Can Anaesth Soc J, 1984;31: 178-187.

05. Carvalho WA, Vianna PTG, Braz JRC - Náuseas e vômitos em anestesia: fisiopatologia e tratamento. Rev Bras Anestesiol, 1999;49:65-79.

06. Muir JJ, Warner MA, Offord KP et al - Role of nitrous oxide and other factors in postoperative nausea and vomiting: a randomized and blinded prospective study. Anesthesiology, 1987; 66:513-518.

07. Kenny GNC - Risk factors for postoperative nausea and vomiting. Anaesthesia, 1994;49:6-10.

08. Beattie WS, Lindbland T, Buckley DN et al - The incidence of postoperative nausea and vomiting in womem undegoing laparoscopy is influenced by the menstrual cycle. Can J Anaesth, 1991;38:298-302.

09. Buckley FP - Anesthesia and obesity and gastrointestinal disorders, em: Barash PG, Cullen BF, Stoelting RK - Clinical Anesthesia, 2nd Ed, Philadelphia, JB Lippincott, 1992;1169-1183.

10. Read NW, Houghton LA - Physiology of gastric emptying and the pathophysiology of gastroparesis. Gastroenterol Clin North Am, 1989;18:359-373.

11. Lerman J - Surgical and patient factors involved in postoperative nausea and vomiting. Br J Anaesth, 1992;69:24S-32S

12. Lichtor JL, Wetchler BV - Anesthesia for Ambulatory Surgery, em: Barash PG, Cullen BF, Stoelting RK - Clinical Anesthesia. 3rd Ed, New York, Lippincott-Raven, 1997;1140-1158.

13. Rabey PG, Smith G - Anaesthetic factors contributing to postoperative nausea and vomiting. Br J Anaesth, 1992;69:40S-45S.

14. Terra ESH - Náusea e Vômito no Pós-Operatório, em: Auler JOC, Vane LA - Curso de Atualização. São Paulo, Atheneu, 1994;8: 1-8.11.

15. Gooding JM, Smith RA, Weng JT et al - Etomidate: clinical experience with a new solvent. Anesthesiology, 1979;6:23-26.

16. Morgan M, Lumley J, Whitwam JG - Respiratory effects of etomidate. Br J Anaesth, 1977;49: 233-236.

17. Smith I, White PF, Nathanson M et al - Propofol. An update on its clinical use. Anesthesiology, 1994;81:1005-1043.

18. Reimer EJ, Montgomery CJ, Bevan et al - Propofol anaesthesia reduces early postoperative emesis after paediatric strabismus surgery. Can J Anaesth, 1993;40:927-933.

19. Shafer A, Doze VA, Shafer SL et al - Pharmacokinetics and pharmacodynamics of propofol infusions during general anesthesia. Anesthesiology, 1988;69:348-356.

20. Borgeat A, Wilder-Smith OHG, Saiah M et al - Subhypnotic doses of propofol possess direct antiemetic properties. Anesth Analg, 1992;74:539-541.

21. Borgeat A, Wilder-Smith OHG, Sutter PM - The nonhypnotic therapeutic applications of propofol. Anesthesiology, 1994;80:642-656.

22. Watcha MF, Simeon RM, White PF et al - Effect of propofol on the incidence of postoperative vomiting after strabismus surgery in pediatric outpatientes. Anesthesiology, 1991;75:204-209.

23. Morris RW, Aune H, Feiss P et al - International, multicentre, placebo-controlled study to evaluate the effectiveness of ondansetron vs. metoclopramide in the prevention of postoperative nausea and vomiting. Eur J Anaesthesiol, 1998; 15:69-79.

24. Pugh SC, Jones NC, Barsoum LZ - A comparison of prophylactic ondansetron and metoclopramide administration in patients undegoing major neurosurgical procedures. Anaesthesia, 1996;51:1162-1164.

25. Raphael JH, Norton AC - Antiemetic efficacy of prophylactic ondansetron in laparoscopic surgery: randomized, double-blind comparison with metoclopramide. Br J Anaesth, 1993; 71:845-848.

26. Rust M - Intravenous ondansetron versus metoclopramide for the prophylaxis of postoperative nausea and vomiting. Anaesthesist, 1995;44:288-290.

27. Apfel CC, Greim CA, Haubitz I et al - A risk score to predict the probability of postoperative vomiting in adults. Acta Anaesthesiol Scand, 1998;42:495-501.

28. Harrington RA. Hamilton CW, Brogden RN et al - Metoclopramide: An updated review of the pharmacological properties and clinical use. Drugs, 1983;25:451-494.

29. Henzi I, Walder B, Tramer MR - Metoclopramide in the prevention of postoperative nausea and vomiting: a quantitative systematic review of randomized, placebo-controlled studies. Br J Anaesth, 1999;83:761-771.

30. Stonham J, Ross S - Antiemetics. Br J Hosp Med, 1984;31: 354-359.

31. Brunton LL - Agentes Affecting Gastrointestinal Water Flux and Motility; Emesis and Antiemetics Bile Acids and Pancreatic Enzymes, em: Hardman JC, Limbird LE, Molinoff PB et al - The Fharmacological Basis of Therapeutics, 9th Ed, New York, Mcgraw-Hill, 1996;917-936.

32. Levitt M, Warr D, Yelle L et al - Ondansetron compared with dexamethasone and metoclopramide as antiemetics in the chemotherapy of breast cancer with cyclophosphamide, methotrexate, and fluorouracil. N Engl J Med, 1993;328:5: 1081-1084.

33. Roila F, Ballastori E, De Angels V et al - Dexamethasone, granisetron or both for the prevention of nausea and vomiting during chemotherapy for cancer. N Engl J Med, 1995; 332:15.

34. Mackenzie R, Tantisira B, Karambelkar DJ et al - Comparison of ondansetron with ondansetron plus dexamethasone in the prevention of postoperative nause and vomiting. Anesth Analg, 1994; 79:961-964.

35. Pueyo FJ, Corrascosa F, Lopez L et al - Combination of ondansetron and droperidol in the prophylaxis of postoperative nausea and vomiting. Anesth Analg, 1996;83:117-122.

36. Splinter WM, Rhine EJ - Low-dose ondansetron with dexamethasone more effectively decreases vomiting after strabismus surgery in children than does high-dose ondansetron. Anesthesiology, 1998;88:72-75.

37. Siegel S - Estadística no Paramétrica Aplicada a las Ciências de la Conducta, 2ª Ed, México, Editorial Trilas, 1975;346.

38. Hollander M, Wolfe DA - Nonparametric Statistical Methods. New York, John Wiley & Sons, 1973;503.

39. Sokal RR, Rohlf FJ - Biometry. San Francisco, W.H. Freeman and company, 1969;776.

40. Korttila K - Can we predict who will vomit after surgery? Acta Anaesthesiol Scand, 1998;42:493-494.

41. Alexander R, Fennelly M - Comparison of ondansetron, metoclopramide and placebo as premedicants to reduce nausea and vomiting after major surgery. Anaesthesia, 1977;2: 695-703.

42. Fujii Y, Saitoh Y, Tanaka H et al - Prevention of PONV with granisetron, droperidol or metoclopramide in patients with postoperative emesis. Can J Anaesth, 1998;45:153-158.

43. Chen PP, Chui PT, Gin T - Comparasion of ondansetron and metoclopramide for the prevention of postoperative nausea and vomiting after major gynaecological surgery. Eur J Anaesthesiol, 1996;13:485-491.

44. Alon E, Himmelseher S - Ondansetron in the treatment of postoperative vomiting: a randomized, double-blind comparison with droperidol and metoclopramide. Anesth Analg, 1992;75: 561-565.

45. Desilva PH, Darvish AH, McDonald SM et al - The efficacy of prophylactic ondansetron, droperidol, perphenazine, and metoclopramide in the prevention of nausea and vomiting after major gynecological surgery. Anesth Analg, 1995;81: 139-145.

46. Malins AF, Field JM, Nesling PM et al - Nausea and vomiting after gynaecological laparoscopy: comparison of premedication with oral ondansetron, metoclopramide and placebo. Br J Anaesth, 1994;72:231-233.

47. Paxton LD, McKay AC, Mirakhur RK - Prevention of nausea and vomiting after day case gynaecological laparoscopy. Anaesthesia, 1995;50:403-406.

48. Rowbotham DJ - Current management of postoperative nausea and vomiting. Br J Anaesth, 1992;69:46S-49S.

49. Madej TH, Simpson KH - Comparison of the use of domperidone, droperidol and metoclopramide in the prevention of nausea and vomiting following gynaecological surgery in day cases. Br J Anaesth, 1986;58:879-883.

50. Tang J, Watcha MF, White PF - A comparison of costs and efficacy of ondansetron and droperidol as prophylactic antiemetic therapy for elective outpatient gynaecologic procedures. Anesth Analg, 1996;83:304-313.

51. Monagle J, Barnes R, Goodchid C et al - Ondansetron is not superior to moderate dose metoclopramide in the prevention of postoperative nausea and vomiting after minor gynaecological surgery. Eur J Anaesthesiol, 1997;14:604-609.