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Category: Volume 05 Issue 10 October 2017
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Title: The Prophylactic Effect of Timing of Dexamethasone on Postoperative Nausea and Vomiting in Patients Undergoing General Anaesthesia – A Randomised Double Blinded Placebo Controlled Study

Authors: Dr E. Ralleen Jacob, Dr N.K.Sekaran

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i10.132

Abstract

Introduction: Patients continue to experience Post Operative Nausea and Vomiting as one of the most distressing problem, inspite of the recent advances in anaesthesia that tends to reduce the adverse outcomes. Around 20%-30% of patients undergoing general anaesthesia experience post operative nausea, vomiting or both. Post operative nausea and vomiting (PONV) was defined as nausea or vomiting within 24 hrs of surgery. The general incidence of vomiting was about 30%, the incidence of nausea was 50%, and in case of high-risk patients, the PONV rate can be as high as 80%.  When PONV was not taken care of, it may result in prolonged post anaesthesia care unit (PACU) stay which significantly increased the health care costs.

Aim: To decrease the incidence of postoperative nausea and vomiting in patients undergoing general anaesthesia upon timing of prophylactic administration of dexamethasone.

Materials and Methods: Patients of age group 25-45 years who are scheduled for elective surgeries under general anaesthesia were identified as target population. Excluded were the patients with the history of motion sickness or any gastro oesophageal reflux disorders, patients who had received antiemetics within 48 hours before surgery, duration of surgery exceeding more than 4 hours and pregnant or menstruating women. At one minute before the induction of anaesthesia, Group 1 received 8 mg (2ml) of IV Dexamethasone, whereas Groups 2, 3 received 2ml of IV saline. At the end of administration of anaesthesia, ie. After tracheal extubation, Group 2 received 8 mg (2ml) of IV Dexamethasone whereas Groups 1, 3 received 2ml of IV saline. The randomised process and the identity of the study drug were blinded from the patients, the anaesthesiologists during surgery.

Results: The incidence of PONV was evaluated. During the postoperative period of 0–2 h, patients in Group 1 reported a less frequent incidence ofPONV(15%) than those in Groups 2 and 3 (50% and 52.5%, respectively). Patients in Group 1 also requested less rescue antiemetic (7.5%) than those in Groups 2 and 3 (32.5% and 37.5%, respectively). During the postoperative period of 2–24 h, patients in Group 1reported less frequent incidences of PONV (17.5%), patients in Group 2 reported 28% incidence of PONV. Both requested rescue anti emetics of  about 10% and 20% respectively. Patients in Group 3 reported 50% incidence of PONV and 32.5% patients requested rescue anti emetics.

Conclusion: In conclusion, the prophylactic IV administration of dexamethasone immediately before the induction, rather than at the end of anaesthesia, was more effective in preventing PONV.

Keywords:  Postoperative nausea and vomiting, Dexamethasone.

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Corresponding Author

Dr E. Ralleen Jacob

Post Graduate Student, Dept of Anaesthesia,

Rajah Muthiah Medical College and Hospital, Chidambaram, Tamil Nadu, India