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Post discharge nausea and vomiting after ambulatory laparoscopy is not reduced by promethazine prophylaxis

  • Joel L. Parlow
  • Andrew T. Meikle
  • Janet van Vlymen
  • Nicole Avery
Reports of Investigation

Abstract

Purpose

To determine the incidence of post-discharge nausea and vomiting (PDNV) following outpatient laparoscopic procedures in women, and to assess the efficacy of the prophylactic administration of promethazine prior to discharge from hospital.

Methods

Ninety-five healthy women scheduled for ambulatory laparoscopic cholecystectomy or gynecological surgery completed this double blind, placebo controlled study. A standardized fentanyl-propofol-nitrous oxideisoflurane anesthetic was used, and all patients received 0.5 mg droperidoliv, intraoperatively. Subjects were randomized to receive 0.6 mg·kg−1 promethazine or placeboim prior to transfer from the post-anesthetic recovery (PAR) unit. The incidence and severity of nausea, pain, and drowsiness were documented using patient diaries at four time intervals during the first 24 hr postoperatively using four-point self-assessment scales.

Results

After discharge home, the overall incidence of nausea was 48%, moderate to severe nausea 30%, vomiting 17% and rescue antiemetic use 28%, with no difference between those receiving saline or promethazine. The need for antiemetics in the PAR was associated with subsequent PDNV with those requiring PAR antiemetics being four times as likely to vomit after discharge (P = 0.008).

Conclusion

Despite the prophylactic administration of 0.5 mg droperidoliv, patients undergoing ambulatory laparoscopic surgery reported a high incidence of nausea after discharge. Patients requiring antiemetics in the PAR were at higher risk for PDNV. The incidence of nausea was not altered by prophylactic administration of 0.6 mg·kg−1 promethazine im before discharge.

Keywords

Laparoscopic Cholecystectomy Ondansetron Granisetron Droperidol Postoperative Nausea 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Résumé

Objectif

Déterminer l’incidence de nausées et de vomissements postcongé (NVPC) après une laparoscopie ambulatoire et évaluer l’efficacité de l’administration prophylactique de prométhazine avant le départ de l’hôpital.

Méthode

Quatre-vingt-dix femmes en santé, qui ont subi une cholécystectomie laparoscopique ou une intervention gynécologique, élective et ambulatoire, ont participé à une étude en double aveugle contre placebo. L’anesthésie était standard: fentanyl, propofol, protoxyde d’azote et isoflurane. Toutes les patientes ont reçu 0,5 mg de dropéridoliv peropératoire. Elles ont été réparties de façon aléatoire et ont reçu, soit 0,6 mg·kg−1 de prométhazine, soit un placeboim avant le transfert de la salle de réveil. L’incidence et la sévérité des nausées et des vomissements, de la douleur et de la somnolence ont été documentées en utilisant ce que les patientes ont noté à quatre reprises pendant les premières 24h postopératoires selon des échelles d’évaluation personnelle en quatre points.

Résultats

Après le congé, l’incidence globale de nausées a été de 48%; de nausées modérées ou sévères, 30%; de vomissements, 17% et de recours aux antiémétiques, 28%, sans différence intergroupe (placebovs prométhazine). La demande d’antiémétiques à la salle de réveil était associée aux NVPC subséquents, les patientes qui ont reçu ces antiémétiques étant quatre fois plus à risque de vomir après le départ de l’hôpital (P = 0,008).

Conclusion

Malgré l’administration prophylactique de 0,5 mg de dropéridoliv, les patientes qui subissent une opération laparoscopique ambulatoire ont rapporté une forte incidence de nausées après le congé de l’hôpital. Celles qui ont eu besoin d’antiémétiques à la salle de réveil étaient plus à risque de NVPC. L’incidence des nausées n’a pas été modifiée par l’administration prophylactique de 0,6 mg·kg−1 de prométhazineim avant le départ.

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Copyright information

© Canadian Anesthesiologists 1999

Authors and Affiliations

  • Joel L. Parlow
    • 1
  • Andrew T. Meikle
    • 1
  • Janet van Vlymen
    • 1
  • Nicole Avery
    • 1
  1. 1.Department of Anesthesiology and Critical CareQueen’s UniversityOntarioCanada

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