Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Apr-Jun;12(2):396-401.
doi: 10.4103/aer.AER_19_18.

Minimum Effective dose of Dexamethasone in Combination with Midazolam as Prophylaxis against Postoperative Nausea and Vomiting after Laparoscopic Cholecystectomy

Rakhi Gupta  1 , Shashi Srivastava  2 , Sanjay Dhiraaj  2 , Puja P Chovatiya  3
Affiliations

Minimum Effective dose of Dexamethasone in Combination with Midazolam as Prophylaxis against Postoperative Nausea and Vomiting after Laparoscopic Cholecystectomy

Rakhi Gupta et al. Anesth Essays Res. 2018 Apr-Jun.

Abstract

Background: Postoperative nausea and vomiting (PONV) affects 20% and 30% of patients. As many as 60%-80% patients at high risk may be affected. Dexamethasone (D) and midazolam (M) are well studied as antiemetic. Use of D can be associated with certain undesirable side effects so minimum dose is preferred. M is a routinely used premedicant. Hence, this study was designed with both D and M in high risk patients for PONV to find minimum effective dose of D.

Aims: To determine the minimum dose of D that combined with M would provide effective prophylaxis of PONV after laparoscopic cholecystectomy (LC) in patients at high risk for PONV.

Setting and design: This is a prospective, randomized double-blind trial.

Materials and methods: One hundred and fifty-five patients scheduled for elective LC were randomized to 5 groups of 31 each. Group C was given normal saline, and the rest were administered D 1 mg (group MD1), 2 mg (group MD2), 4 mg (group MD4), or 8 mg (group MD8) in combination with 0.04 mg/kg M at induction. The incidence of nausea, vomiting, severity of nausea, and the use of rescue antiemetic and postoperative pain was analyzed.

Statistical analysis: Chi-square test was used to compare incidence of study variables. Independent Student's t-test was used for continuous variables. Demographic data were compared using ANOVA. P < 0.05 was considered statistically significant.

Results: The incidence of nausea was significantly lower in group MD4 (29%) and MD8 (6%) compared to placebo group (71%) (P < 0.001) and of vomiting was significantly lower in groups of MD2 (58%), MD4 (48%), and MD8 (6%) compared with placebo (90%) (P < 0.001) at 24 h. There was significant reduction in nausea, pain severity, and incidence of use of rescue antiemetic in MD4 and MD8 groups with no discernable side effects of the drugs.

Conclusion: We conclude that 4 mg D with M and 2 mg D with M is effective for prevention of nausea and vomiting, respectively, in patients at high risk for PONV undergoing LC.

Keywords: Dexamethasone; laparoscopic surgery; midazolam; postoperative nausea and vomiting.

PubMed Disclaimer

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Consort Flow Diagram
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Kovac AL. Prevention and treatment of postoperative nausea and vomiting. Drugs. 2000;59:213–43. - PubMed
    1. Watcha MF, White PF. Postoperative nausea and vomiting. Its etiology, treatment, and prevention. Anesthesiology. 1992;77:162–84. - PubMed
    1. Apfel CC, Läärä E, Koivuranta M, Greim CA, Roewer N. A simplified risk score for predicting postoperative nausea and vomiting: Conclusions from cross-validations between two centers. Anesthesiology. 1999;91:693–700. - PubMed
    1. Gan TJ. Risk factors for postoperative nausea and vomiting. Anesth Analg. 2006;102:1884–98. - PubMed
    1. Arslan M, Ciçek R, Kalender HÜ, Yilmaz H. Preventing postoperative nausea and vomiting after laparoscopic cholecystectomy: A prospective, randomized, double-blind study. Curr Ther Res Clin Exp. 2011;72:1–2. - PMC - PubMed