title: A prospective, randomized, double blind and placebo-control study comparing the additive effect of oral midazolam and clonidine for postoperative nausea and vomiting prophylaxis in granisetron premedicated patients undergoing laparoscopic cholecystecomy.
abstract: BACKGROUND
  Reduction of postoperative nausea and vomiting (PONV) continues to be a major challenge in perioperative care in spite of introduction of newer antiemetics with better efficacy and safety profiles. Therefore, we evaluated the additive effect of oral midazolam and clonidine for PONV prophylaxis in granisetron premedicated patients undergoing laparoscopic cholecystectomy.
  
  
  METHODS
  In a prospective, randomized fashion, 120 selected cases were randomized into three groups: I, II or III to receive a tablet of midazolam (15 mg, n = 36), clonidine (150 mcg, n = 40), or glucose as placebo (5 g, n = 44) orally, 1 h before anesthesia. Occurrence of PONV along with need for rescue antiemetic during the first postoperative day was compared between groups as a primary outcome.
  
  
  RESULTS
  Episodes of PONV reduced significantly in Group II (15%) as compared to group I and III (22.2%, 59%) at various time points during the period of observation (P = 0.002). Need for rescue antiemetic was significantly lower in group I (13.88%) and II (5%) as compared to group III (52.27%, P < 0.001).
  
  
  CONCLUSIONS
  Oral clonidine is better adjuvant for PONV prophylaxis, as compared to midazolam, in granisetron premedicated patients undergoing laparoscopic cholecystectomy.
authors.affiliation: Department of Anesthesiology, Sir Sunder Lal Hospital, Institute of Medical Sciences, BHU, Varanasi, Uttar Pradesh, India.
authors.forename: Ghanshyam
authors.initials: G
authors.lastname: Yadav
authors.forename: Biranchi Narayan
authors.initials: BN
authors.lastname: Pratihary
authors.forename: Gaurav
authors.initials: G
authors.lastname: Jain
authors.forename: Anil Kumar
authors.initials: AK
authors.lastname: Paswan
authors.forename: Lal Dhar
authors.initials: LD
authors.lastname: Mishra
keywords: Clonidine; PONV prophylaxis; granisetron premedicated; midazolam