‘’TO STUDY THE ANTIEMETIC PROPERTIES OF PROPOFOL IN ABDOMINAL SURGERIES’’
Main Article Content
Keywords
postoperative nausea and vomiting, antiemetic
Abstract
Background: Postoperative Nausea and Vomiting (PONV) is a dreadful and uncomfortable experience that significantly detracts patient's quality of life after surgery. Symptoms affecting patients undergoing abdominal surgery under general anaesthesia. It is also associated with complications such as gastric aspiration, bleeding, dehydration, wound dehiscence and delayed hospital discharge. Use of volatile anesthetic agents, prolonged duration of surgery, pain/anxiety, women, nonsmokers, obesity, use of opioids are certain factors which are proven to increase the incidence of PONV. The present study compared the antiemetic effect of ondansetron versus propofol for prevention of postoperative nausea and vomiting in patients undergoing open abdominal surgery under general anaesthesia.
Objectives: ‘’To study the antiemetic properties of propofol in abdominal surgeries’’
Methods: This study was conducted in the Department of Anaesthesiology & Critical Care, Dr. S. N. Medical College, and Jodhpur after obtaining institutional ethical committee approval and written informed consent from study subjects. Patients meeting the inclusion criteria were included in the study between august 2021 to January 2022. This was a prospective Double Blind Randomized Comparative Trial. The patients were divided into two groups of 35 each and were allocated to the groups by computer generated random number table method as follows:
- Group P: Patients receiving Propofol
- Group O: Patients receiving Ondansetron
In the post-operative period, incidence of nausea and vomiting was diagnosed by the use of PONV score and VNRS scale and sedation by Ramsay sedation score for postop till stay in PACU, along with Aldrete score for discharging patients from PACU. Time for extubation and time for need of first rescue antiemetic after extubation was noted. The incidence of PONV and mean total frequency of rescue antiemetic used in 24 hour postoperatively among the two groups was compared.
Results & Discussion -
Results were analysed statistically and were discussed as under. Demographics and Haemodynamic changes were minimal between both groups and statistically not significant. At time 0hr, 2hr, 4hr, 6hr, 12hr and 24 hr postoperatively we compared nausea and vomiting score in patients of P and O group. It is statistically not significant (P>0.05) in terms of requirement of mean dose of rescue antiemetic 24 hrs postop. Incidence of PONV is statistically significant at 5-6hr for group P and at 6-7 hour for group O postoperatively. So sub hypnotic dose of propofol 30 mg is comparable to ondansetron for reducing the incidence of nausea and vomiting in abdominal surgeries for first 6 hours, when they administered as a bolus 15-20 minutes before skin closure in adults undergoing abdominal surgeries under sevoflurane anaesthesia. Time for extubation in group O was 14.31±1.15 mints and in group P was 14.6±2.00 minutes. Time to stay in PACU after recovery room discharge was 83.91±9.22 minutes in group O and 81.45±7.29 in group P. Both results are comparable in both groups and statistically not significant. Time for first rescue antiemetic dose in group O was 7.18±0.76 hrs. and in group P, it was 5.55±0.52 hours. So we can infer that patients with propofol as antiemetic for postop PONV prophylaxis requires rescue antiemetic earlier than patients with ondansetron as prophylaxis. Mean Sedation score in first two hours postop was 1.31±0.47 in group O and 1.49±0.51 in group P, Mean Aldrete score for discharge from PACU for first two hours postop was 9.54±0.51 in group O and 9.4±0.5 in group P. Both results are comparable in both groups and statistically not significant. Difference in the overall incidence of side effects observed of both groups was statistically insignificant (P> 0.05).
Conclusion: From this study it can be concluded that sub hypnotic dose of propofol is comparable to ondansetron as conventional therapy for preventing PONV in patients undergoing general anaesthesia for abdominal surgery in terms of incidence and severity of nausea and vomiting and requirement of rescue antiemetic.
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Dr. Rashmi Gupta
Md Anaesthesiology, Senior Resident Nscb Medical College Jabalpur Mp
Dr. Sneha Gupta
Md, Dnb Anaesthesiology, Ex. Senior Resident Gmc Shahdol Mp
Dr Pramod Pandey
Department Of Anaesthesiology King George's Medical University, Lucknow, Uttar Pradesh, India 226003
Dr. Nishitha Divakar
Md Anaesthesiology, Senior Resident Nscb Medical College Jabalpur Mp