DefinePK

Research Objective

To assess symptoms of nausea and vomiting in laparoscopic cholecystectomy post-operatively, administered anesthesia by sevoflurane or propofol, and to assess the effect of dexamethasone and ondansetron anti-emetic combination.

Methodology

An experimental study design conducted at Rawal General & Dental Hospital. 160 patients with gallstones planned for laparoscopic cholecystectomy, classified as ASA physical status class I-II, were recruited. Patients were allocated to two groups (n=80 each): Group A received anesthetic induction with propofol (1-2 mg/kg), and Group B received anesthetic induction with sevoflurane (4-8%), both in combination with oxygen. Maintenance anesthesia in both groups involved 2% sevoflurane and 50% nitrous oxide in oxygen. All patients received dexamethasone 8mg and ondansetron 4mg at induction and ondansetron 4mg before extubation. The primary endpoint was the rate of nausea and vomiting within 24 hours post-surgery.

Methodology Flowchart

                        graph TD;
    A["Patient Recruitment n=160, ASA I-II"] --> B["Random Allocation"];
    B --> C["Group A: Propofol Induction"];
    B --> D["Group B: Sevoflurane Induction"];
    C --> E["Administer Dexamethasone & Ondansetron"];
    D --> E;
    E --> F["Maintenance Anesthesia Sevoflurane/N2O"];
    F --> G["Surgical Procedure Laparoscopic Cholecystectomy"];
    G --> H["Administer Ondansetron Pre-extubation"];
    H --> I["Post-Anesthesia Care Unit Monitoring"];
    I --> J["Assess Nausea & Vomiting 24 hours"];
    J --> K["Data Analysis"];
    K --> L["Conclusion"];                    

Discussion

The study suggests that while sevoflurane might traditionally be linked to a higher risk of post-surgical nausea and vomiting compared to propofol, the use of an antiemetic combination (dexamethasone and ondansetron) effectively mitigates this risk. The combination of these antiemetics, administered at induction and before extubation, proved effective in preventing post-operative nausea and vomiting in laparoscopic cholecystectomy patients. The study also noted that maintaining intra-abdominal pressure below 10 cm H2O is important for reducing nausea.

Key Findings

Both sevoflurane and propofol were found to be equally effective anesthetic induction agents. The combination of dexamethasone and ondansetron was administered to both groups, nullifying the actual effect of the anesthesia drugs in terms of side effects related to nausea and vomiting. No significant difference was observed in the incidence of post-operative nausea and vomiting between the propofol and sevoflurane induction groups up to 24 hours post-surgery.

Conclusion

In laparoscopic cholecystectomy, both sevoflurane and propofol are suitable anesthetic agents when administered with the dexamethasone and ondansetron anti-emetic combination, effectively managing post-operative nausea and vomiting for up to 24 hours.

Fact Check

* Study Duration: The study was conducted from October 8, 2017, to July 11, 2018.
* Sample Size: A total of 160 patients were recruited, with 80 allocated to each group.
* Anti-emetic Dosage: Dexamethasone 8mg and ondansetron 4mg were administered at induction, and ondansetron 4mg was given before extubation.

Mind Map