Premedication with mirtazapine reduces preoperative anxiety and postoperative nausea and vomiting.
BACKGROUND
Mirtazapine is a new antidepressant that blocks 5-HT2 and 5-HT3 receptors. With this receptor profile, it is possible that mirtazapine could provide both anxiolysis and efficacy for postoperative nausea and vomiting (PONV). We therefore tested the hypothesis that premedication with mirtazapine can reduce preoperative anxiety and PONV.


METHODS
Eighty female patients with at least two PONV risk factors scheduled for gynecological surgery were enrolled. Dexamethasone 8 mg was given before induction of anesthesia and patients were randomly assigned to group M + D (mirtazapine plus dexamethasone) or group dexamethasone. An oral disintegrating mirtazapine 30 mg or placebo tablet was given 1 h before surgery. Preoperative anxiety level was assessed by a visual analog scale (VAS) before mirtazapine administration and 1 h thereafter. General anesthesia was induced with 1% propofol at the rate of 200 mL/h (until loss of consciousness) and was then maintained with sevoflurane in oxygen and air. An auditory evoked potentials index monitor was used to titrate sevoflurane. The incidence of PONV, the use of rescue antiemetic, complete response, postoperative Ramsay Sedation Scores, and VAS pain scores were assessed 1, 2, and 24 h after surgery and compared.


RESULTS
The VAS anxiety scale was lower in group M + D after mirtazapine administration. There were no differences in the induction dose of propofol, the concentrations of sevoflurane during anesthesia, and recovery times between the two groups. The incidence of complete response to PONV over 0-24 h was lower in group M + D (80% vs 50%, P < 0.01).


CONCLUSIONS
Premedication with mirtazapine 30 mg reduces the level of preoperative anxiety and the risk of PONV in moderate and high-risk female patients.
Chen
Chien-Chuan
CC
Department of Anesthesiology, Mackay Memorial Hospital, Taipei, Taiwan.
Lin
Chia-Shiang
CS
Ko
Yuan-Pi
YP
Hung
Yu-Chun
YC
Lao
Hsuan-Chih
HC
Hsu
Yung-Wei
YW
D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use; D014151:Anti-Anxiety Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000932:Antiemetics / Q000009:adverse effects / Q000627:therapeutic use*; D001007:Anxiety / Q000517:prevention & control*; D004311:Double-Blind Method; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D008803:Mianserin / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008875:Middle Aged; D000078785:Mirtazapine; D009020:Morphine / Q000627:therapeutic use; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control*; D011229:Preanesthetic Medication; D012702:Serotonin Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D014151:Anti-Anxiety Agents; D000932:Antiemetics; D012702:Serotonin Antagonists; D008803:Mianserin; D009020:Morphine; D000078785:Mirtazapine