|
|
October 16-20, 2010 San Diego, CA Home Abstract Archive Search Abstracts 2010 Session Grid 2010 Meeting Website Policy Statements ASA Website Feedback 
Visit Anesthesiology.org |
| Previous Abstract | Next Abstract |
| Printable Version |
|
A1069
October 20, 2009 9:00 AM - 11:00 AM Room Area E |
||||||||||||||||||||||||
| Comparison of Dexamethasone and Promethazine for the Treatment of Postoperative Nausea and Vomiting | ||||||||||||||||||||||||
|
**
Fiona K. Danahy, M.D., Alessia Lucignano, M.D., Tong J. Gan, M.B., F.R.C.A., Ashraf S. Habib, M.B., F.R.C.A. Anesthesiology, Duke University Medical Center, Durham, North Carolina |
||||||||||||||||||||||||
|
Introduction:
The efficacy of dexamethasone as a prophylactic anti-emetic has been well established. It has been suggested that administration at induction of anesthesia will result in increased efficacy in the early postoperative period. However; there have been no studies to evaluate its efficacy in the treatment of established post-operative nausea and vomiting (PONV). With increasing numbers of ambulatory surgeries, the need for antiemetics with minimal sedating side effects is increasing as well. While promethazine has proven to be an effective rescue antiemetic, it can be associated with increased sedation. The slow onset of dexamethasone may make it not an ideal choice as a rescue option. The aim of this study was to compare the efficacy of dexamethasone versus promethazine for the treatment of PONV in patients who failed prophylaxis with ondansetron. Methods: The perioperative database was prospectively designed to collect PONV outcome variables. Patients over the age of 18 who received general anesthesia with prophylactic ondansetron administration from April 2001 to June 2005 were sought. We included those who underwent a variety of surgical procedures of 30 to 240 minute duration. We did not include patients who underwent neurosurgical, ENT or procedures when dexamethasone is routinely given as a part of the operative care. Patients who received either promethazine or dexamethasone in the postanesthesia care unit (PACU) as the first line rescue antiemetic for established PONV were included. These patients were included only if they remained in PACU for greater than 30 minutes following administration of the rescue antiemetic. Complete response was defined as no further nausea, vomiting, or need for additional antiemetics in the PACU. Fisher's exact test was used for categorical data and t-test was used for continuous data. A p value <0.05 was considered statistically significant. Results: 659 patients met the inclusion criteria and were included in the analysis. Of these, 568 received promethazine and 91 received dexamethasone as the first rescue antiemetic in PACU. There was no difference between the groups in age, duration of surgery, duration of PACU stay, or opioids received in PACU. Patients in the promethazine group however received significantly higher doses of opioids intraoperatively (p=0.0001). The complete response rate following rescue with dexamethasone was lower when compared to promethazine (66 % vs. 56 %), however the difference was not statistically significant (P=0.0581). The results are summarized in the table.[table1] Conclusion: In patients who experienced PONV despite prophylactic administration of ondansetron, there was a trend for a higher response rate following rescue with promethazine compared with dexamethasone. Large prospective randomized studies are needed to further evaluate the efficacy of dexamethasone for the rescue treatment of PONV. From Proceedings of the 2009 Annual Meeting of the American Society Anesthesiologists. |
||||||||||||||||||||||||
|