Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942002000400002
Brazilian Journal of Anesthesiology
Scientific Article

Eficácia do propofol e da associação de propofol e dexametasona no controle de náusea e vômito no pós-operatório de laparoscopia ginecológica

Efficacy of propofol and propofol plus dexamethasone in controlling postoperative nausea and vomiting of gynecologic laparoscopy

Eliana Marisa Ganem; Fernanda B Fukushima; Daniela S Medeiros da Silva; Giane Nakamura; Yara Marcondes Machado Castiglia; Pedro Thadeu Galvão Vianna

http://dx.doi.org/10.1590/S0034-70942002000400002 Braz J Anesthesiol, vol.52, n4, p.394-401, 2002
PDF
Downloads: 1
Views: 1117

Resumo

JUSTIFICATIVA E OBJETIVOS: A laparoscopia ginecológica é procedimento que determina alta incidência de náusea e vômito no pós-operatório. Este estudo teve por finalidade comparar a eficácia do propofol isoladamente ou em associação com a dexametasona na prevenção de náusea e vômito em pacientes submetidas à laparoscopia ginecológica. MÉTODO: Participaram do estudo 40 pacientes, estado físico ASA I e II, com idades entre 18 e 46 anos, sem queixas gástricas prévias, submetidas à laparoscopia para diagnóstico ou cirurgia. As pacientes foram divididas em 2 grupos: o grupo 1 recebeu (solução fisiológica 2 ml) e o grupo 2 dexametasona (8 mg), por via venosa antes da indução da anestesia. Todas as pacientes receberam midazolam (7,5 mg) por via oral como medicação pré-anestésica, sufentanil (0,5 µg.kg-1), propofol em infusão contínua para indução e manutenção da anestesia (BIS - 60) e N2O/O2 em fração inspirada de O2 a 40% e atracúrio (0,5 mg.kg-1) como bloqueador neuromuscular. A analgesia pós-operatória foi realizada com cetoprofeno (100 mg) e buscopam composto ®.As pacientes fora avaliadas na sala de recuperação pós-anestésica (SRPA) e na enfermaria 1, 2, 3 e 12 horas após a alta da SRPA. RESULTADOS: Ambos os grupos foram idênticos quanto aos dados antropométricos e à duração da cirurgia e da anestesia. No grupo 1 (n = 20) uma paciente apresentou náusea na SRPA e na enfermaria e três pacientes vomitaram na enfermaria. No grupo 2 (n = 20) nenhuma paciente apresentou náusea ou vômito durante o período de observação clínica, resultados estatisticamente não significativos. CONCLUSÕES: O propofol isoladamente ou associado à dexametasona foi eficaz na prevenção de náusea e vômito no pós-operatório de pacientes submetidas à laparoscopia ginecológica

Palavras-chave

CIRURGIA, CIRURGIA, COMPLICAÇÕES, vômito, DROGAS, HIPNÓTICOS

Abstract

BACKGROUND AND OBJECTIVES: Gynecological laparoscopy is a procedure associated to a high incidence of postoperative nausea and vomiting (PONV). This study aimed at comparing the efficacy of propofol or propofol plus dexamethasone in preventing PONV in patients submitted to gynecological laparoscopy. METHODS: Forty female patients, physical status ASA I and II, aged 18 to 46 years, with no previous gastric complaint, undergoing diagnostic or surgical laparoscopy were randomly distri- buted in 2 groups: Group 1 - patients were given 2 ml IV saline solution, while Group 2 was given intravenous dexamethasone (8 mg), before anesthetic induction. All patients were premedicated with oral midazolam (7.5 mg) and induced with sufentanil (0.5 µg.kg-1) and propofol targed controlled infusion (BIS 60), with N2O/O2 (F I O2=0.4) for maintenance. Neuromuscular block was obtained with atracurium (0.5 mg.kg-1). Postoperative analgesia consisted of ketoprofen (100 mg) and butyl-eschopolamine plus dipirone. Patients were evaluated in the PACU and in the ward after 1, 2, 3 and 12 hours after PACU discharge. RESULTS: Both groups were identical regarding demographics data as well as surgery and anesthesia duration. One Group 1 patient referred nausea in postanesthetic care unit and in the ward, and 3 patients referred vomiting in the ward. In Group 2, no patient referred nausea and vomiting, but the difference was not statistically significant. CONCLUSIONS: Propofol or propofol plus dexamethasone were efficient in preventing PONV in patients submitted to gynecological laparoscopy.

Keywords

COMPLICATIONS, DRUGS, HYPNOTICS, SURGERY, SURGERY

References

Sckacel M, Sengupta P, Plantevin OM. Morbidity after day case laparoscopy: A comparison of two techniques of tracheal anaesthesia. Anaesthesia. 1986;41:537-541.

Collins KM, Plantevin OM, Docherty PW. Comparison of atracurium and alcuronium in day case gynaecological surgery. Anaesthesia. 1984;39:1130-1134.

Okum GS, Colonna-Romano P, Horrow JC. Vomiting after alfentanil anesthesia: Effect of dosing method. Anesth Analg. 1992;75:558-560.

Kapur PA. The big "Little Problem". Anesth Analg. 1991;73:243-245.

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

Larsson S, Lundberg D. A prospective survey of postoperative nausea and vomiting with special regard to incidence and relations to patient characteristics, anesthetic routines and surgical procedures. Acta Anaesthesiol Scand. 1995;39:539-545.

Grood PMRM, Harbers JBM, Egmond J. Anaesthesia for laparoscopy. Anaesthesia. 1987;42:815-823.

Raftery S, Sherry E. Total intravenous anaesthesia with propofol and alfentanil protects against postoperative nausea and vomiting. Can J Anaesth. 1992;39:37-40.

Green G, Jansson L. Nausea: The most important factor determining length of stay after ambulatory anaesthesia. A comparative study of isoflurane and/or propofol techniques. Acta Anaesthesiol Scand. 1993;37:742-746.

Klockgether-Radke A, PioreK V, Crozier T. Nausea and vomiting after laparoscopic surgery: a comparison of propofol and thiopentone/halothane anaesthesia. Eur J Anaesthesiol. 1996;13:3-9.

Pavlin DJ, Coda B, Shen DD. Effects of combining propofol and alfentanil on ventilation, analgesia, sedation, and emesis in human volunteers. Anesthesiology. 1996;84:23-37.

Sniadach MS, Alberts MS. A comparison of the prophylactic antiemetic effect of ondansetron and droperidol on patients undergoing gynecologic laparoscopy. Anesth Analg. 1997;85:797-800.

White PF. Anesthetic techniques for ambulatory surgery. American Society of Anesthesiologists Annual Refresher Course Lectures. 1993;121:1-7.

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

Lacroix G, Lessard MR, Trépanier CA. Treatment of post-operative nausea and vomiting: comparison of propofol, droperidol and metoclopramide. Can J Anaesth. 1996;43:115-120.

Wang JJ, Ho ST, Lui YH. Dexamethasone reduces nausea and vomiting after laparoscopic cholecystectomy. Br J Anaesth. 1999;83:772-775.

Rajeeva V, Bhardwaj N, Batra YK. Comparison of ondansetron with ondansetron and dexamethasone in prevention of POVN on diagnostic laparoscopy. Can J Anaesth. 1999;46:40-44.

Sneyd JR, Carr A, Byrom WD. A meta-analysis of nausea and vomiting following maintenance of anaesthesia with propofol or inhalational agents. Eur J Anaesthesiol. 1998;15:433-445.

Coloma M, Duffy LL, White PF. Dexamethasone facilitates discharge after outpatient anorectae surgery. Anesth Analg. 2001;92:85-88.

Chiu JW, White PF. Nonopioid Intravenous Anesthesia. Clinical Anesthesia. 2001:333-334.

Standl T, Wilhelm S, von Knobelsdorff G. Propofol reduces emesis after sufentanil supplemented anaesthesia in paediatric squint surgery. Acta Anaesthesiol Scand. 1996;40:729-733.

Brooker CD, Sutherland J, Cousins MJ. Propofol maintenance to reduce postoperative emesis in thyroidectomy patients: a group sequential comparison with isoflurane/nitrous oxide. Anaesth Intensive Care. 1998;26:625-629.

Sebel PS, Lowdon JP. Propofol: a new intravenous anesthetic. Anesthesiology. 1989;71:260-277.

Drapkin RL, Soke GH. The antiemetic effect and dose response of dexamethasone in patients receiving cis-platinum. Proc Am S Clin Onc. 1982;1:64.

Pappas ALS, Sukhani R, Hotaling AJ. The effect of preoperative dexamethasone on the immediate and delayed postoperative morbidity in children undergoing adenotonsillectomy. Anesth Analg. 1998;87:57-61.

Splinter WM, Roberts DJ. Prophylaxis for vomiting by children after tonsillectomy: dexamethasone versus perphenazine. Anesth Analg. 1997;85:534-537.

Fujii Y, Tanaka H, Toyooko H. The effects of dexamethasone on antiemetics in female patients undergoing gynecologic surgery. Anesth Analg. 1997;85:913-917.

Lopez-Olaondo LL, Carrascosa F, Pueyo FJ. Combination of ondansetron and dexamethasone in the prophylaxis of postoperative nausea and vomiting. Br J Anaesth. 1996;76:835-840.

Wang JJ, Ho ST, Liu HS. Prophylactic antiemetic effect of dexamethasone in women undergoing ambulatory laparoscopic surgery. Br J Anaesth. 2000;84:459-462.

Brady ME, Sartiano GP, Rosenblum JL. The pharmacokinetics of single high dose of dexamethasone in cancer patients. Eur J Clin Pharmacol. 1987;32:593-596.

Schimmer BP, Parker KL. Adrenocorticotropic Hormone: Adrenocortical Steroids and their Synthetic Analogs: Inhibitors of the Synthesis and Actions of Adrenocortical Hormones. Goodman and Gilman’s - The Pharmacological Basis of Therapeutics. 2001:1649-1677.

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

Aapro MS, Alberts DS. Dexamethasone as an antiemetic in patients treated with cisplatin. N Engl J Med. 1981;305:520.

Baxendale BR, Valter M, Lavery KM. Dexamethasone reduces pain and swelling following extraction of third molar teeth. Anaesthesia. 1993;43:961-964.

Sekine I, Nishiwaki Y, Kakinuma R. Phase II study of high-dose dexamethasone-based association in acute and delayed high-dose cisplatin-induced emesis-JCOG study 9413. Br J Cancer. 1997;76:90-92.

Dexamethasone, Ganisetron, or both for the prevention of nausea and vomiting during chemotherapy for cancer. N Engl J Med. 1995;332:1-5.

Ondansetron versus Metoclopramide, both combined with dexamethasone, in the prevention of cisplatin-induced delayed emesis. J Clin Onc. 1997;15:124-130.

Henzi I, Walder B, Tramèr MR. Dexamethasone for the prevention of postoperative nausea and vomiting: a quantitative systematic review. Anesth Analg. 2000;90:186-194.

Rich W, Abdulhayoglu G, Di Saia PJ. Methylprednisolone as antiemetic during cancer chemotherapy: a pilot study. Gynecol Oncol. 1980;9:193-198.

Harris AL. Cytotoxic-therapy-induced vomiting is mediated via enkephalin pathways. Lancet. 1982;1:714-716.

Morimoto M, Morita N, Ozawa H. Distribution of glucocorticoid receptor immunoreactivity and mRNA in the rat brain: an immunohistochemical and in situ hybridization study. Neurosc Res. 1996;26:235-269.

Funder JW. Mineralocorticoid receptors and glucocorticoid receptors. Clin Endocrinol. 1996;45:651-656.

Naylor RJ, Inall FC. The physiology and pharmacology of postoperative nausea and vomiting. Anaesthesia. 1994;49:2-5.

Beattie WS, Lindblad T, Buckley DN. The incidence of post-operative nausea and vomiting in women undergoing laparoscopy is influenced by the day menstrual cycle. Can J Anaesth. 1991;38:298-302.

Beattie WS, Lindblad T, Buckley DN. Menstruation increases the risk of nausea and vomiting after laparoscopy. Anesthesiology. 1993;78:272-276.

Ganem EM, Fabris P, Moro MZ. Eficácia do ondansetron e da alizaprida na prevenção de náusea e vômito em laparoscopia ginecológica. Rev Bras Anestesiol. 2001;51:401-406.

5dd587360e8825ef3dc8fca9 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections