title: Preventing postoperative nausea and vomiting after laparoscopic cholecystectomy: a prospective, randomized, double-blind study.
abstract: BACKGROUND
  Postoperative nausea and vomiting (PONV) are potential complications in patients after laparoscopic cholecystectomy (LC). Combination antiemetic therapy often is effective for preventing PONV in patients undergoing LC, and combinations of antiemetics targeting different sites of activity may be more effective than monotherapy.
  
  
  OBJECTIVE
  The aim of this study was to compare the administration of a subhypnotic dose of propofol combined with dexamethasone with one of propofol combined with metoclopramide to prevent PONV after LC.
  
  
  METHODS
  Sixty adult patients scheduled for LC were randomly assigned to 1 of 2 treatment groups. The patients in group 1 received 0.5 mg/kg propofol plus 8 mg dexamethasone, and those in group 2 received 0.5 mg/kg propofol plus 0.2 mg/kg metoclopramide. The number of patients experiencing nausea and vomiting at 0 to 4, 4 to 12, and 12 to 24 hours postoperatively and as well as additional use of rescue antiemetics were recorded.
  
  
  RESULTS
  The total PONV rates up to 24 hours postanesthesia were 23.3% and 50% for group 1 and group 2, respectively. Comparisons of the data revealed that at 0 to 4 hours, the number of patients experiencing vomiting was 6 (20%) in group 1 and14 (46.7%) in group 2 (P = 0.028). The frequency of vomiting in group 1 was significantly lower than that for group 2 (P = 0.028), and the rate of rescue antiemetic use in group 2 was higher than that in group 1 (20% vs 46.7%; P = 0.028). In the evaluation of PONV based on the nausea and vomiting scale scores, the mean PONV score was 0.4 (0.2) in group 1 compared with 1.0 (0.2) in group 2 (P = 0.017). There were no significant differences between the values at 4 to 12 hours and at 12 to 24 hours. The frequency of adverse reactions (respiratory depression: 1.3%, 1.3%; laryngospasm: 1.3%, 0%; cough: 1.3%, 0%; hiccup: 1.3%, 0%;) was not significantly different in the 2 groups.
  
  
  CONCLUSIONS
  Administration of a subhypnotic dose of 0.5 mg/kg propofol plus 8 mg dexamethasone at the end of surgery was more effective than administration of 0.5 mg/kg propofol plus metoclopramide in preventing PONV in the early postoperative period in adult patients undergoing LC.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Gazi University Faculty of Dentistry, Ankara, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Arslan
authors.affiliation: Department of Anaesthesiology and Reanimation, Yüksek İhtisas Hospital, Kırıkkale, Turkey.
authors.forename: Ramazan
authors.initials: R
authors.lastname: Ciçek
authors.affiliation: Department of General Surgery, Yüksek İhtisas Hospital, Kırıkkale, Turkey.
authors.forename: Hülya Üstün
authors.initials: HÜ
authors.lastname: Kalender
authors.affiliation: Department of General Surgery, Yüksek İhtisas Hospital, Kırıkkale, Turkey.
authors.forename: Hüseyin
authors.initials: H
authors.lastname: Yilmaz
keywords: dexamethasone; laparoscopic cholecystectomy; metoclopramide; postoperative nausea and vomiting; propofol