A Comparison of Sub-hypnotic Dose of Propofol with Dexamethasone for the Prevention of Postoperative Nausea and Vomiting in Patients Undergoing Laparoscopic Cholecystectomy

Background and Objective: Post operative nausea and vomiting (PONV) are unpleasant feelings which frequently occur after laparoscopic cholecystectomy. The aim of this study was to compare the effectiveness of dexamethasone and propofol in prevention of PONV in patients undergoing laparoscopic cholecystectomy. Materials and Methods: ۶۰ patients with ASA status ۱-۲, who had undergone laparoscopic cholecystectomy with similar general anesthesia were selected and were randomly assigned to one of the three groups (۲۰ patients in each group). Group I received ۰.۵ mg/kg propofol (i.v), group II received ۸ mg dexamethasone (i.v) and group III received normal salin ۹.۰% (i.v) as placebo, following the completion of surgery, ۱ and ۲۴ hours after the surgery patients with ۰-۲ level of consciousness were questioned about the presence of nausea and vomiting. Results: Over ۱ to ۲۴ hours after the surgery, PONV in the dexamethasone group was significantly less than the other groups. Also the incidence of PONV in the Propofol group was lower compared to Placebo group. Conclusion: A single dose of dexamethasone after surgery is effective in prevention of PONV in laparoscopic cholecystectomy. Also the incidence of PONV can be effectively reduced with Propofol. References ۱- Fujii Y, Nakayama M. Prevention of postoperative nausea and vomiting with a small dose of propofol alone and combined with dexamethasone in patients undergoing laparoscopic cholecystectomy: A prospective, randomized, double-blined study. Surge Endosc. ۲۰۰۸ ۲۲: ۱۲۶۸-۷۱. ۲- Wang JJ, Ho ST, Liu YH, et al. Dexamethasone reduce nausea and vomiting after laparoscopic cholecystectomy. Br J Anaesth. ۱۹۹۹ ۸۳: ۷۷۲-۵. ۳- Bisgaard T, Klarskov B, Kehlet H, Rosenberg J. Preoperative dexamethasone improve surgical outcome after laparoscopic cholecystectomy. Ann Surg. ۲۰۰۳ ۲۳۸: ۶۵۱-۶۰. ۴- Fujii Y. Management of postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy. Surg Endosc. ۲۰۱۱ ۲۵: ۶۹۱-۵. ۵- Wang JJ, Ho ST, Uen YH, et al. Small dose dexamethasone reduce nausea and vomiting after laparoscopic cholecystectomy: A comparison of tropisetron with saline. Anesth Analg. ۲۰۰۲ ۹۵: ۲۲۹-۳۲. ۶- Fukami Y, Terasaki M, Okamoto Y, et al. Efficacy of preoperative dexamethasone in patients with laparoscopic cholecystectomy: A prospective, randomized, double-blined study. J Hepatobiliary Pancreat Surg. ۲۰۰۹ ۱۶: ۳۶۷-۷۱. ۷- Erhan Y, Erhan E, Aydede H, Yumus O, Yentur A. Ondansetron, granisetrone and dexamethasone compared for the prevention of postoperative nausea and vomiting in patients undergoing laparascopic cholecystectomy: A randomized placebo-controlled study. Surg Endosc. ۲۰۰۸ ۲۲: ۱۴۸۷-۹۲. ۸- Yoo YC, Bai SJ, Lee KY, Shin S, Choi EK, Lee JW. Total intravenous anesthesia with propofol reduces prostoprative nausea and vomiting in patients undergoing robot assisted laparascopic radical prostatectomy. Yonsei Med J. ۲۰۱۲ ۵۳: ۱۱۹۷-۱۲۰۲. ۹- Arsalan M, Demir ME. Prevention of postoperative nausea and vomiting with a small dose of propofol combined with dexamethasone ۴ mg or dexamethasone ۸ mg in patients undergoing middle ear surgery: a prospective, randomized, double-blind study. Bratisl Lek Listy. ۲۰۱۱ ۱۱۲: ۳۳۲-۶. ۱۰- Sanchez-Rodriquez PE, Fuentes Orozco C, Gonzalez Ojeda A. Effect of dexamethasone on postoperative symptom in patient undergoing elective laparoscopic cholecystectomy. World J Surgery. ۲۰۱۰ ۳۴: ۸۹۵-۹۰۰. ۱۱- Fujli Y, Itakura M. Reduction of postoperative nausea, vomiting, and analgesic requirement with dexamethasone for patients undergoing laparoscopic cholecystectomy. Surg Endosc. ۲۰۱۰ ۲۴: ۶۹۲-۶. ۱۲- Hosseini N, Mousavi nassab N, Salimi H. The assessment of result of laparoscopic cholecystectomy in Valiasr and Shafeiieh hospital in Zanjan. Zanjan Univ Med Sci J. ۲۰۰۵ ۵۰: ۵۱-۵۵. ۱۳- Ryu JH, Chang JE, Kim tlR, Hwang JW, Oh AY, Do SH. Ramosetron vs ramosetron plus dexamethasone for the prevention of postoperative nausea and vomiting (PONV) after laparoscopic chole cystectomy prospectiue, romdomized, and double- blind study. Int J Surg. ۲۰۱۳ ۱۱: ۱۸۳-۷. ۱۴- Fujii Y, Itakura M, Low dose propofol to prevent nausea and vomiting after laparoscopic surgery. Int J Gynecol. ۲۰۰۹ ۱۰۶: ۵۰-۲۰. ۱۵- Nesek-Adam V, Grizelj-Stojcic E, Rasic Z, Cala Z, Mrsic V, Smiljanic A. Comparison of dexamethasone, Metoclopramid and their combination in the prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy. Suvg Endosc. ۲۰۰۷ ۲۱: ۶۰۷-۱۲.

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Key words: Laparoscopic cholecystectomy , Post operative nausea and vomiting , Dexamethasone , Propofol