Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942008000100005
Brazilian Journal of Anesthesiology
Scientific Article

Profilaxia antiemética em cirurgia de abdome agudo: estudo comparativo entre droperidol, metoclopramida, tropisetron, granisetron e dexametasona

Prophylactic antiemetic therapy for acute abdominal surgery: a comparative study of droperidol, metoclopramide, tropisetron, granisetron and dexamethasone

Víctor Contreras-Domínguez; Paulina Carbonell-Bellolio

http://dx.doi.org/10.1590/S0034-70942008000100005 Braz J Anesthesiol, vol.58, n1, p.35-44, 2008
PDF Português
PDF English
Downloads: 0
Views: 1125

Resumo

JUSTIFICATIVA E OBJETIVOS: A incidência de náuseas e vômitos pós-operatórios (NVPO) gira em torno de 30%. A profilaxia de NVPO foi objeto de múltiplos estudos, tanto para tentar diminuir esse problema como para comparar o índice custo-benefício do tratamento utilizado. Esse estudo comparou a eficácia de cinco fármacos antieméticos em apendicectomia. MÉTODO: Estudo clínico prospectivo controlado, duplamente encoberto de 150 pacientes ASA I e II com IMC < 30, submetidos a apendicectomia. Os pacientes foram divididos em seis grupos: Grupo 1 (n = 25): 5 mL solução fisiológica a 0,9%; Grupo 2 (n = 25): droperidol 0,625 mg; Grupo 3 (n = 25): metoclopramida 20 mg; Grupo 4 (n = 25): tropisetron 5 mg; Grupo 5 (n = 25): granisetron 1 mg; Grupo 6 (n = 25): dexametasona 4 mg. A monitoração foi realizada com ECG, PANI, SpO2, P ET CO2, analisador de gases anestésicos e estimulador de nervo periférico. Foi avaliada a presença de NVPO, complicações e o grau de satisfação nas primeiras 48 horas. RESULTADOS: O droperidol apresentou incidência 4% de NVPO, os grupos de granisetron, tropisetron e metoclopramida apresentaram 12% de NVPO (p < 0,05). O grupo de dexametasona apresentou 24% e o controle 28% de NVPO. CONCLUSÕES: Na profilaxia de NVPO em apendicectomia de urgência o uso de baixas doses de droperidol foi mais efetivo que o dos outros fármacos.

Palavras-chave

ANTIEMÉTICOS, ANTIEMÉTICOS, ANTIEMÉTICOS, ANTIEMÉTICOS, ANTIEMÉTICOS, CIRURGIA, CIRURGIA, COMPLICAÇÕES, COMPLICAÇÕES

Abstract

BACKGROUND AND OBJECTIVES: It is calculated that the incidence of postoperative nausea and vomiting (PONV) is approximately 30%. The prophylaxis of PONV has been the subject of several studies, both to decrease this problem and to compare the cost-benefit ration of the treatment used. The objective of this study was to compare the efficacy of 5 antiemetic drugs with a control group in emergency appendectomy. METHODS: A controlled, double-blind, prospective study with 150 patients, ASA I and II, BMI < 30, undergoing appendectomy, was undertaken. Patients were divided in six groups: Group 1 (n = 25): 5 mL of normal saline; Group 2 (n = 25): 0.625 mg of droperidol; Group 3 (n = 25): 20 mg of metoclopramide; Group 4 (n = 25): 5 mg of tropisetron; Group 5 (n = 25): 1 mg of granisetron; Group 6 (n = 25): 4 mg of dexamethasone. Monitoring included ECG, non-invasive blood pressure, O2 saturation, P ET CO2, anesthetic gas analyzer and peripheral nerve stimulator. The presence of PONV, complications and the degree of satisfaction in the first 48 hours were evaluated. RESULTS: The incidence of PONV in the droperidol group was 4% while in the granisetron, tropisetron and metoclopramide groups it was 12% (p < 0.05). The dexamethasone group had a 24% incidence and the control group 28%. CONCLUSIONS: Low doses of droperidol were more effective in the prophylaxis of PONV in emergency appendectomy than the other drugs.

Keywords

ANTIEMETICS, ANTIEMETICS, ANTIEMETICS, ANTIEMETICS, ANTIEMETICS, COMPLICATIONS, COMPLICATIONS, SURGERY, SURGERY

Referencias

, . Nausea and vomiting after general anaesthesia. Lancet. 1989;1:651-652.

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

Naguib M, El Barky AK, Khoshim MHB. Prophylactic antiemetic therapy with ondansetron, tropisetron, granisetron and metoclopramide in patients undergoing laparoscopic cholecystectomy: a randomized, double blind comparison with placebo. Can J Anaesth. 1996;43:226-231.

Alon E, Kocian R, Nett Ph. Tropisetron for the prevention of postoperative nausea and vomiting in women undergoing gynecologic surgery. Anesth Analg. 1996;82:338-341.

Janknegt R, Pinkaers JWM, Rohof MHC. Double-blind comparative study of droperidol, granisetron and granisetron plus dexametasone as prophylactic anti-emetic therapy in patients undergoing abdominal gynaecological, breast or otolaryngological surgery. Anaesthesia. 1999;54:1059-1068.

Purhonen S, Kauko M, Koski E. Comparison of tropisetron, droperidol, and saline in prevention of postoperative nausea and vomiting after gynecologic surgery. Anesth Analg. 1997;84:662-67.

Jokela R, Koivuranta M. Tropisetron or droperidol in the prevention of postoperative nausea and vomiting. Acta Anaesthesiol Scand. 1999;43:645-50.

Henzi I, Sonderegger J, Tramer M. Systematic review: efficacy, dose-response, and adverse effects of droperidol for prevention of postoperative nausea and vomiting. Can J Anaesth. 2000;47:537-51.

White PF. Droperidol: a cost-effective antiemetic for over 30 years!. Anesth Analg. 2002;95:789-790.

Bailey P, Norton R, Karan S. The FDA droperidol warning: is it justified?. Anesthesiology. 2002;97:288-289.

Habib AS, Gan TJ. FDA black box warning on the postoperative use of droperidol: a review of the cases. Anesth Analg. 2003;96:1377-1379.

White PJ, Watcha MF. Postoperative nausea and vomiting, profilaxis versus treatment. Anesth Analg. 1999;89:1337-1339.

Coloma M, White PF, Markowitz SD. Dexametasona in combination with dolasetron for prophylaxis in the ambulatory setting. Anesthesiology. 2002;96:1346-1350.

Watcha MF. The cost-effective management of postoperative nausea and vomiting. Anesthesiology. 2000;92:931-933.

Hill RP, Lubarsky DA, Phillips-Bute B. Cost-effectiveness of prophylactic antiemetic therapy with ondansetron, droperidol, or placebo. Anesthesiology. 1998;68:731-738.

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

Gold BS, Kitz DS, Lecky JH. Unanticipated admission to the hospital following ambulatory surgery. JAMA. 1989;262:3008-3010.

Fortier J, Chung F, Su J. Unanticipated admission after ambulatory surgery: a prospective study. Can J Anaesth. 1998;45:612-619.

Gan T, Sloan F, Dear G. How much are patients willing to pay to avoid postoperative nausea and vomiting?. Anesth Analg. 2001;92:393-400.

Cohen MM, Duncan PG, De Boer DP. The postoperative interview: assessing risk factor for nausea and vomiting. Anesth Analg. 1994;78:7-16.

Gan T, Meyer T, Apfel C. Consensus guidelines for managing postoperative nausea and vomiting. Anesth Analg. 2003;97:62-71.

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

Fortney JT, Gan TJ, Graczyk S. A comparison of the efficacy, safety, and patient satisfaction of ondansetron, versus droperidol as antiemetics for elective outpatients' surgical procedures: S3A-409 and S3A-410 study groups. Anesth Analg. 1998;86:731-738.

Gan TJ. Post-operative nausea and vomiting: can it be eliminated?. JAMA. 2002;287:1233-1236.

Zhang Y, Lou Z, White PJ. A model for evaluating droperidol s effects on the median QTc interval. Anesth Analg. 2004;98:1300-1305.

Charbit B, Albaladejo P, Funk-Brentano C. Prolongation of QTc interval alter postoperative nausea and vomiting treatment by droperidol or ondansetron. Anesthesiology. 2005;102:1094-1100.

White PF, Song D, Abrao J. Effect of low dose droperidol on the QT interval during and after general anesthesia. Anesthesiology. 2005;102:1101-1105.

Abreu MP, Vieira JL, Silva IF. Eficácia do ondansetron, metoclopramida, droperidol e dexametasona na prevenção de náusea e vômito após laparoscopia ginecológica em regime ambulatorial: Estudo comparativo. Rev Bras Anestesiol. 2006;56:8-15.

Quaynor H, Reader JC. Incidence and severity of postoperative nausea and vomiting are similar after metoclopramide 20 mg and ondansetron 8 mg given by the end of laparoscopic cholecystectomies. Acta Anaesthesiol Scand. 2002;46:109-113.

Wilson AJ, Diemunsh P, Lindeque BJ. Single-dose iv granisetron in the prevention of postoperative nausea and vomiting. Br J Anaesth. 1996;76:515-518.

Mikawa K, Takao Y, Nishina K. Optimal dose of granisetron for prophylaxis against postoperative emesis after gynecological surgery. Anesth Analg. 1997;85:652-661.

DiBruijn KM. Tropisetron. Drugs. 1992;43:11-22.

Wang JJ, Ho ST, Tzeng JI. The effect of timing of dexametasona administration on its efficacy as a prophylactic antiemetic for postoperative nausea and vomiting. Anesth Analg. 2000;91:136-139.

Liu K, Hsu CC, Chia YY. The effective dose of dexametasona for antiemesis after major gynecological surgery. Anesth Analg. 1999;89:1316-1318.

Wang JJ, Ho ST, Tzeng JI. The use of dexametasona for preventing postoperative nausea and vomiting in females undergoing thyroidectomy: a dose-ranging study. Anesth Analg. 2000;91:1404-1407.

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

Acalovschi I. Postoperative nausea and vomiting. Curr Anaesth Crit Care. 2002;13:37-43.

Muñoz HR, Ibacache ME, Mertz VF. Eficacia de la dexametasona en el tratamiento agudo de nauseas y vómitos posoperatorios: Comparación con droperidol y ondansetrón. Rev Med Chile. 2006;134:697-702.

Ali SZ, Taguchi A, Holtmann B. Effect of supplemental pre-operative fluid on post-operative nausea and vomiting. Anaesthesia. 2003;58:775803.

Maharaj CH, Kallam SR, Malik A. Preoperative intravenous fluid therapy decreases postoperative nausea and pain in high risk patient. Anesth Analg. 2005;100:675-82.

5dd6cf630e8825466413f286 rba Articles
Links & Downloads
2352-2291 (Electrónico) 0104-0014 (Impreso)
Braz J Anesthesiol ©2024 Todos los derechos reservados.

Braz J Anesthesiol

Share this page
Page Sections