DEPARTMENT OF ANAESTHESIOLOGY SCB MEDICAL COLLEGE.SYNOPSIS TITLE OF THE PAPER : COMPARATIVE EVALATION OF THE INFLUENCE OF INTRAVENOUS DEXAMETHASONE AND ONDANSETRON ON POSTOPERATIVE NAUSEA AND VOMITING AFTER LAPROSCOPIC CHOLECYSTECTOMY : DR. CUTTACK NAME OF CANDIDATE : MISHRA DR. . SHAKTI BEDANTA PG STUDENT. NARAYAN ACHARYA ASSOCIATE PROFESSOR. CUTTACK NAME OF THE HOD MOHANTY ANAESTHESIOLOGY : PROF (DR) SHIV NARAYAN PROFESSOR. CUTTACK. DEPARTMENT OF SCB MEDICAL COLLEGE. DEPARTMENT OF NAME OF THE GUIDE ANAESTHESIOLOGY SCB MEDICAL COLLEGE.

As more and more patients undergo surgery as day case. Nausea and vomiting in the postoperative period occurs in 20% to 30% of patients and together are the second most common complaints reported (pain is the most common). . and drugs like droperidol. hyosine. The present study is aimed to assess the magnitude of PONV after laparoscopic cholecystectomy and to evaluate and compare the effects of ondansetron and dexamethasone on the same. metoclopramide.INTRODUCTION Within 18 months of introduction of general anesthesia . not much work has been done to assess the effect of dexamethasone on PONV after laparoscopic cholecystectomy. To assess the magnitude of post operative nausea vomiting (ponv) after laparoscopic cholecystectomy 2. John Snow in 1848 first described the phenomenon of post operative nausea and vomiting. PONV became a medical subject heading in the National Library of Medicine. dysphoretic. & perphenazine. Although various studies have proved the antiemetic efficacy of dexamethasone. and in 1999. A number of pharmacological and non pharmacological methods have been tried in the past with variable success. Post operative nausea and vomiting can increase pain . post operative nausea and vomiting still occurs with n acceptable frequency and the description of it as the “Big Little Problem” encapsulates much of the general perception. Also the studies carried ot so far on PONV after laparoscopic cholecystectomy have used various drugs either alone or in combination bt the comparison of ondansetron and dexamethasone on the same surgical population has not been reported. also adverse effects of single dose of dexamethasone are extremely rare. After the landmark 1992 review from Watcha and White. the humanitarian and economic implications of post operative nausea and vomiting are becoming increasingly important. These include acupuncture. acupressure. postoperative nausea and vomiting (PONV) became the more commonly used clinical term. AIMS AND OBJECTIVES : 1. prolong the post anesthetic care unit (PACU) stay and can cause unplanned hospital admission. However inspite of the advances . is also shown to e effective in preventing and treating PONV. its cost is substantial. and extrapyramidal side effects of other commonly used antiemetics. Although it lacks the sedative. Over the next 150 years there has been a general trend towards a decrease in the incidence and intensity of the problem. To evaluate the effect of dexamethasone on ponv after laparoscopic cholecystectomy. The antiemetic effect of dexamethasone is reported to be equal to or better than 5HT3 antagonists. Ondansetron is a highly selective 5HT3 antagonist. atropine. It has been used successfully in chemotherapy induced emesis. cyclizine.

Hemoglobin estimation b. History of smoking Preanesthetic preparation A detailed preanesthetic checkup was done in all the patients. C. Patient on antiemetic or emetic in last 48 hours. A detailed history was taken and thorough physical examination done. Urine albumin and sugar g. Those with hypersensitivity to ondansetron or dexamethasone D. Differential leucocyte count d. who underwent elective laparoscopic cholecystectomy under general anesthesia. cuttack . To compare the effects of dexamethsone and ondansetron on ponv after laparoscopic cholecystectomy. Chest skiagram . Blood sugar e. The following investigations were carried out in all the patients. REVIEW OF LITERATURE : Literature pertaining to the study were and will be reviewed and in depth with reference from the published data in various journals and books MATERIALS AND METHODS : Selection of patients The present study was conducted on 60 adult Grade 1 or 2 patients of female sex in the age group 18 to 60 admitted to SCB medical college . Blood urea f.3. Total leucocyte count c. F. Pregnant and lactating patients. Steroid therapy E. a. B. History of motion sickness . Exclusion criteria A. 4. To evaluate the effect of ondansetron on ponv after laparoscopic cholecystectomy.

Electrocardiography All patients were shown the Numerical rating scale and were appraised abot the same during a preoperative visit one day prior to study. Pentazocine 0.2mg i. Allocation of the groups. 20-30 mins prior to induction. The patients were asked to restrict oral intake overnight or at least 6 hours before surgery. and injection Midazolam 0. The patients were induced with Propofol 2. Numerical rating scale (for assessing the intensity of nausea) DISCUSSION : All the observations discussed with reference to currently available literature. An informed consent was taken from all the patients. Incidence of nausea and vomiting 5.v. 1.6 mg/kg. Blood pressure 3. The patients were randomly divided into three groups of twenty patients each Group I: Patients in this group served as control and received 10ml of normal saline. Postoperatively the following parameters were recorded at 1.05mg/kg i. inj. Pulse rate 2.5mg were given orally on the night before operation.5mg/kg along with inj. Group II: Patients in this group received dexamethasone 0.24 hours in all the patients. CONCLUSION : .4. Respiratory rate 4.h.v. Anesthetic procedure With preoperative preparation.1mg/kg diluted to 10ml of normal saline.2.15mg/kg diluted to 10ml of normal saline. Glycopyrrolate 0. rocuronium 0.8.5mg/kg i.v. patients were kept overnight fasting and tablet ranitidine 150mg and tablet Alprazolam 0. Premedication was done with inj. all the patients were intubated with appropriate size cuffed endotracheal tube.. Group III: Patients in this group received ondansetron 0.

Wallenborn J. Walder B. Evans R: Logistic regression analysis of fixed patient factors for postoperative sickness: A model for risk assessment. 78:7-16. Anesthesiology 1992. 70:135140. Anesth Analg 2000. Bland JM: Effectiveness of acute postoperative pain management: I. Br J Anaesth 2002. 91:693-700. White PF: Postoperative nausea and vomiting: Its etiology. Watcha MF. et al: Prevention of postoperative nausea and vomiting by metoclopramide combined with dexamethasone: Randomised double blind multicentre trial. Anaesthesia 1997. Tramer MR: Dexamethasone for the prevention of postoperative nausea and vomiting: A quantitative systematic review. Duncan PG. Apfel CC. White PF: Effect of the timing of ondansetron administration on PONV after outpatient laparoscopy. 44:480-488. 89:409-423. Gelbrich G. 85:A9. • • • • Signature of the Candidate Signature of the Guide . Stadler M. Snare L. et al: Evaluation of three risk scores to predict postoperative nausea and vomiting. and prevention. Wender R. Palazzo M. Tang J. Bulst D. conclusion will be discussed in the final dissertation. Laara E. Tzeng JI. Tweed WA: The postoperative interview: Assessing risk factors for nausea and vomiting. DeBoer DP. 333:324-328. Anesth Analg 1994. Koivuranta M. Wang JJ. Bardiau F. Anesthesiology 1999. et al: Difference in risk factors for postoperative nausea and vomiting. BMJ 2006. Ho ST. 90:186194. Anesthesiology 1996. Acta Anaesthesiol Scand 2000. 98:46-52. Cashman JN. Hogel J. Tang CS: The effect of timing of dexamethasone administration on its efficacy as a prophylactic antiemetic for postoperative nausea and vomiting. Laara E. Seidel L. BIBLIOGRAPHY : • • • • • • • • Dolin SJ. et al: A simplified risk score for predicting postoperative nausea and vomiting: Conclusions from cross-validations between two centers. Anesthesiology 2003. Henzi I. 77:162-184. 52:443-449.After reviewing the literature pertaining to the study. Seeling W. 91:136-139. Koivuranta M. Anesth Analg 2000. Wang B. Br J Anaesth 1993. Evidence from published data. treatment. Alahuhta S: A survey of postoperative nausea and vomiting. Eberhart LHJ. Cohen MM.

Signature of the HOD .

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