Effect of Pre-Operative Anti-emetic Medication Administration on Post-Operative Nausea & Vomiting
Anti-emetics are drugs that used to help reduce or prevent nausea, feelings of sickness, and vomiting that is caused during treatment. Burtles and Peckett (1957) assert that pre-operative anti-emetics are therefore drugs used to by postoperative and chemotherapy patients to prevent or reduce post-operative nausea and vomiting (PONV). This is so because chronic vomiting if unchecked will not only make intricacy of mantling proper nutrition and a healthy weight but also it can lead to dehydration that can be a medical emergency.
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Post operative nausea and vomiting have for a long time been attributed to being very unpleasant side effects of anesthesia, leading to dissatisfaction and distress to patients. PONV may occur after local, regional or general anaesthesia and having an overall estimate of approximately 20-30 percent of all adult surgical patients. According to investigations, there are significantly higher cases of nausea and vomiting after surgery in female adults as compared to their male counterparts. In certain gynecological processes, the occurrences of post operative nausea and vomiting after laparoscopic and day care surgeries ranges from 36- 82 percent for the period of immediate post operative recovery.
The effect however, can be as elevated as 73% in some medical gynecological procedures (Rajeeva and Dhaliwal, 1998).
There are a number of anaeshesia related factors that are associated with emesis. The factors include opioids, inhalational agents, patient mobilization, hemodynamic instability and initiative of oral intake. In addition, there area a various kinds of anti-emesis drugs that are being used in hospitals all the united states of America for treatment of post-operative nausea and vomiting. Most hospitals prefer balanced anti-emesis. This happens by a combination of drugs with other with different mechanisms. This of action has been looked at better and worthwhile approach in comparison to single drug therapy. Through extensive studies 5HT3 antagonist Ondansetron and dexamethasone, have been considered the effective ant-emesis for efficient prophylaxis against post operative nausea and vomiting (Burtles and Peckett, 1957).
Many studies have been conducted in hospitals to establish the efficacy of 5HT3 antagonist Ondansetron and in combination with Dexamethasone to prevent post operative nausea and omitting.
One study of this kind was a randomized double blind study that included 60 patients, mainly female aged from 18 to 50 years old. They belonged to either ASA I or II class, undergoing laparoscopic cholecystectomy under general anaesthesia. The patients were allocated into two different groups randomly each having 30 patients. Each patient then received study medication that w2as prepared by one person in identical 5ml syringe. All the study medications had been diluted up to 4ml in 0.9 % saline fro ensuring blinding. Group I patients were given 4 mgs of Ondansetron diluted to 4 ml in 0.9 % (Ondansetron group while). The other one, Group II got a combination of 4mgs of Ondansetron together with 4mgs of dexamethasone diluted to 4ml in 0.9% saline (Combination group).
After surgery in the above case, patients were observed for a period of 24 hour. Recordings were also made on the incidences of nausea and vomiting each after 6 hours for a period of 24 hours. Then, rescue anti-emetic medication was given to in form of injection and repeated in case any patient encountered severe nausea.
The results indicated no statistical difference between the two groups in relation to age, body size, mass index duration of CO2 insufflation and duration of anaesthesia and surgery. There was reported incidence of pain at any incidence in both groups.
The analysis indicated that PNOV has lived for a long time as unpleasant and persistent clinical problem in the surgical patients after anaesthesia. There are main patient related factors of PNOV which include gender, age, history of motion sickness, pregnancy and previous post operative nausea and vomiting. Women are more sensitive to emetic stimuli in comparison to men with more cases being reported. The mechanism of the PNOV in women was found out to draw its complication from the prevailing hormone status and its management being basically based on treatment but not prevention (Rajeeva and Dhaliwal, 1998)
Studies have show that among patients undertaking gynecological laparoscopic surgeries under general anaesthesia, granisetron 40µg/kg is the most preferred because it is safe, cost effective, and an efficient anti-emetic drug (Trammer, 2001)
According to Trammer (2001), Decadron can be used to treat nausea and vomiting that is linked with chemotherapy drugs. The drug has been used for diabetic patients but most doctors have continuously not prescribed this drug to patients.
This is due to the many side effects the drug has. The persistent us of the drug will make the patients experience endure many changes like increased appetite, difficulty in sleeping, the ankles and feet may sometimes swell due to fluid retention, irritability, heartburn. Other forms of side effects that have been observed after using Decadron are impaired wound healing wound healing, muscle weakness and elevated blood sugar levels. In diabetic patients, there arises a need of for monitoring their blood sugar levels closely and also make possible adjustments to diabetes medications. All these have discouraged the use of Decadron.