The most common and distressing symptoms, which follow anaesthesia and surgery, are pain and emesis. The consequences of PONV are physical, surgical and anesthetic complications for patients as well as financial implications for the hospitals or institutions. Sometimes nausea and vomiting may be more distressing especially after minor and ambulatory surgery, delaying the hospital discharge. Laparoscopic surgery is one condition, where risk of PONV is particularly pronounced due to pneumo-peritoneum causing stimulation of mechanoreceptors in the gut. In spite of plenty of anti-emetic drugs available no single drug is 100% effective in prevention of PNV and combination therapy has got a lot of side effects.
Skeletal muscle relaxants work by either depolarizing or competitively blocking nicotinic acetylcholine receptors in the neuromuscular junction. Succinylcholine is a depolarizing agent that causes initial muscle fasciculation and prolonged depolarization before hydrolysis by plasma cholinesterase. Non-depolarizing agents like atracurium and vecuronium are competitive antagonists that bind nicotinic receptors without activating them. They vary in onset, duration and route of elimination depending on whether they are short, intermediate or long acting. Pancuronium and pipecuronium have longer durations due to renal elimination while mivacurium and rapacuronium are shorter acting due to
This document discusses various antiemetic agents used to treat nausea and vomiting. It begins by outlining common causes of nausea and vomiting and the pathophysiology involving the vomiting center and chemoreceptor trigger zone in the brainstem. It then summarizes the mechanisms and clinical uses of major classes of antiemetics including 5-HT3 receptor antagonists, corticosteroids, neurokinin 1 receptor antagonists, phenothiazines, substituted benzamides, anticholinergics, antihistamines, benzodiazepines, and cannabinoids. Adverse effects and drug interactions are also briefly mentioned for each class.
This document discusses macrolide antibiotics, including their mechanism of action, types, and uses. It describes several macrolide antibiotics like erythromycin, clarithromycin, azithromycin, and roxithromycin. It covers their mechanisms of action, spectra of activity, pharmacokinetics, clinical uses, side effects, and interactions. It also briefly discusses newer macrolides like telithromycin and ketolides, as well as the lincosamide antibiotic clindomycin.
Here are the key steps I would follow in selecting an appropriate antibiotic for a patient:
1. Determine if antibiotic treatment is truly necessary based on diagnosis, severity of symptoms, risk factors for complications, etc. Not all infections require antibiotics.
2. Consider the most likely causative organism(s) based on infection type, patient factors, local resistance patterns. Select an antibiotic with appropriate spectrum of activity.
3. Check for any antibiotic allergies and select an agent from a different class if needed.
4. Adjust for special populations like pregnancy, renal dysfunction, liver disease - may need to avoid certain drugs, lower doses, or extend intervals.
5. Determine dosage, administration route, frequency and treatment
The document discusses antiemetics, which are drugs used to treat nausea and vomiting. It defines nausea, vomiting, and antiemetic agents. It describes the vomiting center and chemoreceptor trigger zone in the brain which stimulate vomiting once activated. It explains the different mechanisms of action that various antiemetics use to block vomiting pathways, such as blocking acetylcholine, histamine H1 receptors, dopamine receptors, serotonin receptors, and cannabinoid receptors. Finally, it reviews the indications for different classes of antiemetics in treating conditions like chemotherapy-induced nausea and vomiting, postoperative nausea, and motion sickness.
This document provides information about the anesthetic drug Propofol, including its brand name, generic name, strength, description, pharmacology, mechanism of action, indications, dosage and administration, contraindications, advantages, and competitors. Propofol is an injectable emulsion containing 10 mg/ml of propofol that is formulated for intravenous administration. It acts as a sedative-hypnotic agent and induces hypnosis within 40 seconds of IV injection through activating GABAA receptors. Propofol is indicated for induction and maintenance of general anesthesia as well as sedation of ventilated ICU patients and monitored anesthesia care.
Skeletal muscle relaxants work by either depolarizing or competitively blocking nicotinic acetylcholine receptors in the neuromuscular junction. Succinylcholine is a depolarizing agent that causes initial muscle fasciculation and prolonged depolarization before hydrolysis by plasma cholinesterase. Non-depolarizing agents like atracurium and vecuronium are competitive antagonists that bind nicotinic receptors without activating them. They vary in onset, duration and route of elimination depending on whether they are short, intermediate or long acting. Pancuronium and pipecuronium have longer durations due to renal elimination while mivacurium and rapacuronium are shorter acting due to
This document discusses various antiemetic agents used to treat nausea and vomiting. It begins by outlining common causes of nausea and vomiting and the pathophysiology involving the vomiting center and chemoreceptor trigger zone in the brainstem. It then summarizes the mechanisms and clinical uses of major classes of antiemetics including 5-HT3 receptor antagonists, corticosteroids, neurokinin 1 receptor antagonists, phenothiazines, substituted benzamides, anticholinergics, antihistamines, benzodiazepines, and cannabinoids. Adverse effects and drug interactions are also briefly mentioned for each class.
This document discusses macrolide antibiotics, including their mechanism of action, types, and uses. It describes several macrolide antibiotics like erythromycin, clarithromycin, azithromycin, and roxithromycin. It covers their mechanisms of action, spectra of activity, pharmacokinetics, clinical uses, side effects, and interactions. It also briefly discusses newer macrolides like telithromycin and ketolides, as well as the lincosamide antibiotic clindomycin.
Here are the key steps I would follow in selecting an appropriate antibiotic for a patient:
1. Determine if antibiotic treatment is truly necessary based on diagnosis, severity of symptoms, risk factors for complications, etc. Not all infections require antibiotics.
2. Consider the most likely causative organism(s) based on infection type, patient factors, local resistance patterns. Select an antibiotic with appropriate spectrum of activity.
3. Check for any antibiotic allergies and select an agent from a different class if needed.
4. Adjust for special populations like pregnancy, renal dysfunction, liver disease - may need to avoid certain drugs, lower doses, or extend intervals.
5. Determine dosage, administration route, frequency and treatment
The document discusses antiemetics, which are drugs used to treat nausea and vomiting. It defines nausea, vomiting, and antiemetic agents. It describes the vomiting center and chemoreceptor trigger zone in the brain which stimulate vomiting once activated. It explains the different mechanisms of action that various antiemetics use to block vomiting pathways, such as blocking acetylcholine, histamine H1 receptors, dopamine receptors, serotonin receptors, and cannabinoid receptors. Finally, it reviews the indications for different classes of antiemetics in treating conditions like chemotherapy-induced nausea and vomiting, postoperative nausea, and motion sickness.
This document provides information about the anesthetic drug Propofol, including its brand name, generic name, strength, description, pharmacology, mechanism of action, indications, dosage and administration, contraindications, advantages, and competitors. Propofol is an injectable emulsion containing 10 mg/ml of propofol that is formulated for intravenous administration. It acts as a sedative-hypnotic agent and induces hypnosis within 40 seconds of IV injection through activating GABAA receptors. Propofol is indicated for induction and maintenance of general anesthesia as well as sedation of ventilated ICU patients and monitored anesthesia care.
The document summarizes the mechanism of nausea and vomiting. It discusses that nausea and vomiting are protective reflexes against toxins. The vomiting center in the medulla integrates afferent signals and coordinates the vomiting reflex. The vomiting center can be stimulated through irritation in the gastrointestinal tract, signals from the chemoreceptor trigger zone, stimulation of the vestibular system, or from higher brain centers. When stimulated, the vomiting center initiates the motor pathways that lead to nausea, salivation, and the expulsion of gastric contents through vomiting.
The document discusses emetics and antiemetics. It describes the pathways and receptors involved in vomiting and their stimulation or blockade. It covers various classes of antiemetics including anticholinergics, antihistamines, neuroleptics, prokinetic drugs, 5-HT3 antagonists and adjuvant antiemetics. Specific drugs discussed include metoclopramide, domperidone, ondansetron and corticosteroids. The document provides details on the mechanisms, indications, interactions and side effects of different antiemetic drugs.
The document discusses various preanaesthetic agents used to prepare animals for anesthesia. It describes different classes of preanaesthetics including anticholinergics, tranquilizers, sedatives, and alpha-2 agonists. It provides examples of specific drugs from each class and discusses their mechanisms of action, effects, dosages, and cautions. The purpose of preanaesthetics is to sedate the animal, reduce stress, and facilitate safe and effective induction and recovery from anesthesia.
This document discusses sedative-hypnotic drugs, including benzodiazepines, barbiturates, and other agents. It covers their mechanisms of action, involving facilitation of GABA and inhibition of glutamate. It also summarizes their clinical uses for anxiety, sleep disorders, sedation, seizures and detoxification. Side effects include cognitive impairment. Overdose can cause respiratory and cardiovascular depression.
Opioid pharmacology - A comprehensive subject seminar on OpioidsRohan Kolla
This document provides an outline and overview of opioid pharmacology. It begins with definitions of terms like opioids and opiates. It then discusses the history of opioid use from ancient times through modern drug development. The endogenous opioid system and opioid receptors are described. The pharmacokinetics, pharmacological effects, and clinical uses of various opioids like morphine, fentanyl, methadone, and antagonists are summarized. The document covers both central and peripheral effects of opioids on systems like the nervous, cardiovascular, immune, and gastrointestinal systems. Classification and guidelines for use of opioids in pain management are also mentioned.
This document discusses opioid analgesics and provides details about morphine. It defines opioids as any drug that binds to opioid receptors in the central nervous system and can be antagonized by naloxone. Morphine is described as the prototypical opioid analgesic. Its mechanisms of action include inhibiting neurotransmitter release in the spinal cord and brain. Adverse effects include respiratory depression, sedation, constipation, and dependence with repeated use. Morphine has therapeutic uses for relieving various types of pain but also carries risks in certain patient populations like those with head injuries. The document outlines various opioid classifications and compares properties of representative opioids like morphine, codeine, pethidine, and buprenorphine.
The document discusses various types of analgesics, including opioids and non-opioid analgesics. It provides details on morphine, including its mechanism of action, uses, side effects, and toxicity. It also covers non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin and acetaminophen. NSAIDs work by inhibiting prostaglandin synthesis and reducing inflammation. The document outlines their mechanisms, classifications, uses, and potential side effects.
This slide is based upon prokinetic agents with detailed descriptions of their dosage to be taken with their respective usage in conditions and effects to be careful. I hope you will get the best of your knowledge from the respective material.
The document discusses antihistamines and their use in treating allergies. It outlines the history and prevalence of allergies and describes the role of histamine in the allergic response. There are three generations of antihistamines described - first generation had more side effects while later generations were developed to be more selective for receptors with fewer side effects. The document covers common allergens, symptoms, histamine receptors, allergic reactions, properties of different antihistamine generations, pharmacokinetics, adverse reactions, and the future of allergy treatment.
This document provides an overview of anticholinergic drugs, including:
- Their classification into natural alkaloids, semisynthetic derivatives, and synthetic compounds.
- Their mechanisms of action as muscarinic receptor antagonists and effects on various organ systems like the CNS, eyes, cardiovascular, respiratory, gastrointestinal, and urinary systems.
- Examples of individual drugs from each class and their therapeutic uses for conditions like Parkinson's disease, peptic ulcers, overactive bladder, respiratory diseases, and more.
- Information on pharmacokinetics, pharmacology, interactions, contraindications, and belladonna poisoning from anticholinergic overdose.
This document summarizes different types of analgesics. It is divided into sections on opioid analgesics like morphine, codeine, tramadol, and pethidine. It also discusses non-opioid analgesics and NSAIDs like aspirin, indomethacin, ibuprofen, mefenamic acid, diclofenac, piroxicam, ketorolac, nimesulide, and rofecoxib. Each drug is described in terms of its pharmacological actions, uses, dosages, and adverse effects. Paracetamol is highlighted as a commonly used over-the-counter analgesic that is generally well tolerated and safe.
Opioid analgesics work by binding to opioid receptors in the brain and spinal cord to reduce pain. There are several types of opioid receptors that endogenous opioid peptides and exogenous opioids can bind to, including mu, delta, and kappa receptors. Opioids are well absorbed orally or parenterally and distributed widely throughout the body. They are metabolized in the liver mainly by conjugation with glucuronic acid and excreted in urine. Opioids produce analgesia, sedation, respiratory depression, nausea, vomiting, and constipation by acting on central and peripheral opioid receptors. Tolerance and physical dependence may develop with repeated use.
This document discusses anticholinergic drugs, which are muscarinic receptor blockers that inhibit the actions of acetylcholine. It classifies anticholinergics as natural alkaloids like atropine, semisynthetic derivatives, and synthetic compounds. Atropine is the prototype drug and works by competitively blocking muscarinic receptors. Clinically, atropine causes dry mouth, blurred vision, difficulty swallowing and talking, increased heart rate, decreased gastrointestinal and bronchial secretions, and elevated body temperature. Its substitutes have similar but longer-lasting effects. Common uses include pre-anesthesia, peptic ulcers, asthma, and Parkinson's disease. Atropine poisoning can be
This document discusses the concept of "P-medicines", which are essential medicines selected by each doctor to treat common conditions. It describes how to select a P-medicine by defining the diagnosis, specifying the treatment goal, inventorying effective drug groups, choosing a group based on criteria like efficacy and safety, and selecting a medicine from that group. Examples are provided of selecting P-medicines for angina and prescribing sample treatments. The summary emphasizes rational prescribing by choosing appropriate medicines based on each patient's individual needs.
Hypertension is defined as a systolic blood pressure over 140 mmHg or a diastolic blood pressure over 90 mmHg. It can be caused by environmental factors like stress, high sodium intake, smoking, and obesity. Antihypertensive drugs work through various mechanisms like diuretics which increase sodium excretion, ACE inhibitors which inhibit angiotensin II synthesis, and calcium channel blockers which relax smooth muscles. Lifestyle modifications and medication are important to control blood pressure and prevent complications of hypertension like heart disease and stroke.
The document discusses muscle relaxants and neuromuscular blocking agents. It covers their classification, mechanisms of action, administration, and side effects. Specifically, it describes how succinylcholine causes initial muscle stimulation followed by paralysis through prolonged depolarization of motor end plates. It also notes that residual paralysis can occur in 42% of patients even after administration of reversal agents, and that a train-of-four ratio above 0.7 correlates with clinical recovery.
The document discusses the pathophysiology and treatment of vomiting and nausea. It defines vomiting, nausea, and retching. The vomiting center is located in the medulla and receives input from the GI tract, chemoreceptor trigger zone, and vestibular apparatus. Common causes of vomiting that stimulate the vomiting center are GI irritation, chemotherapy, and motion sickness. Common antiemetics that act on receptors in the vomiting center and trigger zone include 5-HT3 antagonists, dopamine D2 antagonists, H1 antihistamines, anticholinergics, cannabinoids, and NK1 receptor antagonists. Ondansetron is effective for chemotherapy and postoperative nausea but not for motion sickness which acts
Analyses of Risk Factors of Diarrhea in Patients with Esophagectomysemualkaira
Esophageal cancer is one of the most common
cancers of the world and surgery is an effective treatment for that.
However, long-term complications, such as diarrhea, are the focus
on the postoperative quality of life. Until now, the etiologies of
diarrhea after esophagectomy are still ill-defined.
Analyses of Risk Factors of Diarrhea in Patients with Esophagectomysemualkaira
Esophageal cancer is one of the most common cancers of the world and surgery is an effective treatment for that. However, long-term complications, such as diarrhea, are the focus on the postoperative quality of life. Until now, the etiologies of diarrhea after esophagectomy are still ill-defined.
The document summarizes the mechanism of nausea and vomiting. It discusses that nausea and vomiting are protective reflexes against toxins. The vomiting center in the medulla integrates afferent signals and coordinates the vomiting reflex. The vomiting center can be stimulated through irritation in the gastrointestinal tract, signals from the chemoreceptor trigger zone, stimulation of the vestibular system, or from higher brain centers. When stimulated, the vomiting center initiates the motor pathways that lead to nausea, salivation, and the expulsion of gastric contents through vomiting.
The document discusses emetics and antiemetics. It describes the pathways and receptors involved in vomiting and their stimulation or blockade. It covers various classes of antiemetics including anticholinergics, antihistamines, neuroleptics, prokinetic drugs, 5-HT3 antagonists and adjuvant antiemetics. Specific drugs discussed include metoclopramide, domperidone, ondansetron and corticosteroids. The document provides details on the mechanisms, indications, interactions and side effects of different antiemetic drugs.
The document discusses various preanaesthetic agents used to prepare animals for anesthesia. It describes different classes of preanaesthetics including anticholinergics, tranquilizers, sedatives, and alpha-2 agonists. It provides examples of specific drugs from each class and discusses their mechanisms of action, effects, dosages, and cautions. The purpose of preanaesthetics is to sedate the animal, reduce stress, and facilitate safe and effective induction and recovery from anesthesia.
This document discusses sedative-hypnotic drugs, including benzodiazepines, barbiturates, and other agents. It covers their mechanisms of action, involving facilitation of GABA and inhibition of glutamate. It also summarizes their clinical uses for anxiety, sleep disorders, sedation, seizures and detoxification. Side effects include cognitive impairment. Overdose can cause respiratory and cardiovascular depression.
Opioid pharmacology - A comprehensive subject seminar on OpioidsRohan Kolla
This document provides an outline and overview of opioid pharmacology. It begins with definitions of terms like opioids and opiates. It then discusses the history of opioid use from ancient times through modern drug development. The endogenous opioid system and opioid receptors are described. The pharmacokinetics, pharmacological effects, and clinical uses of various opioids like morphine, fentanyl, methadone, and antagonists are summarized. The document covers both central and peripheral effects of opioids on systems like the nervous, cardiovascular, immune, and gastrointestinal systems. Classification and guidelines for use of opioids in pain management are also mentioned.
This document discusses opioid analgesics and provides details about morphine. It defines opioids as any drug that binds to opioid receptors in the central nervous system and can be antagonized by naloxone. Morphine is described as the prototypical opioid analgesic. Its mechanisms of action include inhibiting neurotransmitter release in the spinal cord and brain. Adverse effects include respiratory depression, sedation, constipation, and dependence with repeated use. Morphine has therapeutic uses for relieving various types of pain but also carries risks in certain patient populations like those with head injuries. The document outlines various opioid classifications and compares properties of representative opioids like morphine, codeine, pethidine, and buprenorphine.
The document discusses various types of analgesics, including opioids and non-opioid analgesics. It provides details on morphine, including its mechanism of action, uses, side effects, and toxicity. It also covers non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin and acetaminophen. NSAIDs work by inhibiting prostaglandin synthesis and reducing inflammation. The document outlines their mechanisms, classifications, uses, and potential side effects.
This slide is based upon prokinetic agents with detailed descriptions of their dosage to be taken with their respective usage in conditions and effects to be careful. I hope you will get the best of your knowledge from the respective material.
The document discusses antihistamines and their use in treating allergies. It outlines the history and prevalence of allergies and describes the role of histamine in the allergic response. There are three generations of antihistamines described - first generation had more side effects while later generations were developed to be more selective for receptors with fewer side effects. The document covers common allergens, symptoms, histamine receptors, allergic reactions, properties of different antihistamine generations, pharmacokinetics, adverse reactions, and the future of allergy treatment.
This document provides an overview of anticholinergic drugs, including:
- Their classification into natural alkaloids, semisynthetic derivatives, and synthetic compounds.
- Their mechanisms of action as muscarinic receptor antagonists and effects on various organ systems like the CNS, eyes, cardiovascular, respiratory, gastrointestinal, and urinary systems.
- Examples of individual drugs from each class and their therapeutic uses for conditions like Parkinson's disease, peptic ulcers, overactive bladder, respiratory diseases, and more.
- Information on pharmacokinetics, pharmacology, interactions, contraindications, and belladonna poisoning from anticholinergic overdose.
This document summarizes different types of analgesics. It is divided into sections on opioid analgesics like morphine, codeine, tramadol, and pethidine. It also discusses non-opioid analgesics and NSAIDs like aspirin, indomethacin, ibuprofen, mefenamic acid, diclofenac, piroxicam, ketorolac, nimesulide, and rofecoxib. Each drug is described in terms of its pharmacological actions, uses, dosages, and adverse effects. Paracetamol is highlighted as a commonly used over-the-counter analgesic that is generally well tolerated and safe.
Opioid analgesics work by binding to opioid receptors in the brain and spinal cord to reduce pain. There are several types of opioid receptors that endogenous opioid peptides and exogenous opioids can bind to, including mu, delta, and kappa receptors. Opioids are well absorbed orally or parenterally and distributed widely throughout the body. They are metabolized in the liver mainly by conjugation with glucuronic acid and excreted in urine. Opioids produce analgesia, sedation, respiratory depression, nausea, vomiting, and constipation by acting on central and peripheral opioid receptors. Tolerance and physical dependence may develop with repeated use.
This document discusses anticholinergic drugs, which are muscarinic receptor blockers that inhibit the actions of acetylcholine. It classifies anticholinergics as natural alkaloids like atropine, semisynthetic derivatives, and synthetic compounds. Atropine is the prototype drug and works by competitively blocking muscarinic receptors. Clinically, atropine causes dry mouth, blurred vision, difficulty swallowing and talking, increased heart rate, decreased gastrointestinal and bronchial secretions, and elevated body temperature. Its substitutes have similar but longer-lasting effects. Common uses include pre-anesthesia, peptic ulcers, asthma, and Parkinson's disease. Atropine poisoning can be
This document discusses the concept of "P-medicines", which are essential medicines selected by each doctor to treat common conditions. It describes how to select a P-medicine by defining the diagnosis, specifying the treatment goal, inventorying effective drug groups, choosing a group based on criteria like efficacy and safety, and selecting a medicine from that group. Examples are provided of selecting P-medicines for angina and prescribing sample treatments. The summary emphasizes rational prescribing by choosing appropriate medicines based on each patient's individual needs.
Hypertension is defined as a systolic blood pressure over 140 mmHg or a diastolic blood pressure over 90 mmHg. It can be caused by environmental factors like stress, high sodium intake, smoking, and obesity. Antihypertensive drugs work through various mechanisms like diuretics which increase sodium excretion, ACE inhibitors which inhibit angiotensin II synthesis, and calcium channel blockers which relax smooth muscles. Lifestyle modifications and medication are important to control blood pressure and prevent complications of hypertension like heart disease and stroke.
The document discusses muscle relaxants and neuromuscular blocking agents. It covers their classification, mechanisms of action, administration, and side effects. Specifically, it describes how succinylcholine causes initial muscle stimulation followed by paralysis through prolonged depolarization of motor end plates. It also notes that residual paralysis can occur in 42% of patients even after administration of reversal agents, and that a train-of-four ratio above 0.7 correlates with clinical recovery.
The document discusses the pathophysiology and treatment of vomiting and nausea. It defines vomiting, nausea, and retching. The vomiting center is located in the medulla and receives input from the GI tract, chemoreceptor trigger zone, and vestibular apparatus. Common causes of vomiting that stimulate the vomiting center are GI irritation, chemotherapy, and motion sickness. Common antiemetics that act on receptors in the vomiting center and trigger zone include 5-HT3 antagonists, dopamine D2 antagonists, H1 antihistamines, anticholinergics, cannabinoids, and NK1 receptor antagonists. Ondansetron is effective for chemotherapy and postoperative nausea but not for motion sickness which acts
Analyses of Risk Factors of Diarrhea in Patients with Esophagectomysemualkaira
Esophageal cancer is one of the most common
cancers of the world and surgery is an effective treatment for that.
However, long-term complications, such as diarrhea, are the focus
on the postoperative quality of life. Until now, the etiologies of
diarrhea after esophagectomy are still ill-defined.
Analyses of Risk Factors of Diarrhea in Patients with Esophagectomysemualkaira
Esophageal cancer is one of the most common cancers of the world and surgery is an effective treatment for that. However, long-term complications, such as diarrhea, are the focus on the postoperative quality of life. Until now, the etiologies of diarrhea after esophagectomy are still ill-defined.
FUNCTION AFTER OPEN ABDOMINAL AORTIC POSOPERATIVE PULMONARY ANEURYSM REPAIR ...Felipe Posada
1) The study compared postoperative pulmonary function and pain control in COPD patients undergoing open abdominal aortic aneurysm repair with either epidural (Group I) or intravenous (Group II) analgesia.
2) Pulmonary function test (FEV1 and FVC) results were significantly better preserved in Group I patients on postoperative days 1 and 4.
3) Group I patients also had significantly less reported pain on postoperative days 1, 2, and 4 both at rest and during activity.
4) There were no differences in length of hospital stay, morbidity, or mortality between the groups.
This research article compares the effectiveness of oral versus intravenous proton pump inhibitors (PPIs) in preventing re-bleeding in patients with peptic ulcer bleeding after successful endoscopic therapy. 100 patients were randomly assigned to receive either oral lansoprazole or intravenous esomeprazole after endoscopic hemostasis. The re-bleeding rates within 14 days were similar between the two groups. Patients receiving oral PPI had a shorter hospital stay. While no differences in clinical outcomes were found, the study was not powered to prove equivalence between the oral and intravenous PPI treatments. Larger studies are still needed to further compare the effectiveness of oral versus intravenous PPI administration.
This study analyzed early postoperative complications in 145 adult patients who received total intravenous anesthesia (TIVA) with propofol and remifentanil for elective neurosurgery. The authors found:
1) The overall incidence of shivering was 30.3%, postoperative nausea and vomiting (PONV) was 16.6%, and postoperative hypertension (blood pressure over 25% of preoperative value) was 35.2%.
2) 51% of patients experienced at least one of these complications. Complication rates varied significantly between surgical groups.
3) The intracranial vascular surgery group had the highest rates of shivering (58.8%) and PONV (29.4
This study analyzed early postoperative complications in 145 adult patients who received total intravenous anesthesia (TIVA) with propofol and remifentanil for elective neurosurgery. The authors found:
1) The overall incidence of shivering was 30.3%, postoperative nausea and vomiting (PONV) was 16.6%, and postoperative hypertension (blood pressure over 25% of preoperative value) was 35.2%.
2) 51% of patients experienced at least one of these complications. Complication rates varied significantly between surgical groups.
3) The intracranial vascular surgery group had the highest rates of shivering (58.8%) and PONV (29.4
Ottimizzazione degli scambi respiratoiri intraoperatori ( e postopClaudio Melloni
This study evaluated the effect of different intraoperative ventilatory strategies on preventing pulmonary atelectasis in obese patients undergoing laparoscopic bariatric surgery. Sixty-six obese patients were randomly assigned to receive either a vital capacity maneuver with zero end-expiratory pressure, a vital capacity maneuver with 5 cm H2O positive end-expiratory pressure, or a vital capacity maneuver with 10 cm H2O positive end-expiratory pressure. Outcome measures including oxygenation, hemodynamics, length of stay in post-anesthesia care unit, and postoperative computed tomography scans were compared. The results showed that applying positive end-expiratory pressure, especially 10 cm H2O, in addition to a vital capacity
Awake Fiberoptic Intubation with Sedation in Cardiac (High-Risk) Patients – O...info622939
Embark on a compelling exploration of anesthesia innovation with our presentation on 'Awake Fiberoptic Intubation with Sedation in Cardiac (High-Risk) Patients – Our Experience.' Delve into the intricacies of this specialized technique, tailored for high-risk cardiac patients, as we share our unique insights and experiences.
Management Of Patient Undergoing Surgerykalyan kumar
The document discusses the management of patients undergoing surgery. It covers the three main phases of surgical management: pre-operative, intra-operative, and post-operative management. For pre-operative management, the document outlines the physical, psychosocial, physiological preparations and assessments a patient undergoes before surgery including examinations, investigations, pre-medications. It then briefly describes the roles of the surgical team during intra-operative management. Finally, it discusses the immediate post-operative recovery phase in PACU and management of common post-operative complications.
1. This study investigated the incidence of abdominal pain in patients receiving remifentanil versus fentanyl for anesthesia during cataract surgery.
2. The study found that 52.6% of patients who received remifentanil experienced postoperative abdominal pain, compared to only 2% of patients who received fentanyl.
3. Severe abdominal pain requiring intervention occurred in 6.7% of remifentanil patients but none of the fentanyl patients. The cause of remifentanil-induced abdominal pain is unknown.
The document discusses preoperative, intraoperative, and postoperative care for a patient undergoing surgery. In the preoperative stage, patients undergo assessments of their medical history and comorbidities, labs and tests are ordered to optimize the patient's health status, and the surgical plan is arranged. Intraoperatively, strict infection control protocols are followed and checklists are used to ensure safety. Postoperatively, patients are monitored, complications are prevented, and care is documented before discharge. The overall goal is to safely prepare the patient for surgery, perform the procedure, and provide care during recovery.
Antiemetic Prophylaxis in Major Gynaecological Surgery With Intravenous Grani...inventionjournals
In a randomized double-blind study, researchers compared the efficacy of granisetron versus metoclopramide for preventing postoperative nausea and vomiting (PONV) in 50 female patients undergoing major gynecological surgery. Patients received either granisetron 40mcg/kg or metoclopramide 0.15mg/kg before surgery. Incidence of PONV was assessed over 24 hours. While both drugs effectively prevented PONV in the first 4 hours, granisetron was more effective over the next 20 hours, with a 12% incidence of PONV versus 48% for metoclopramide. Nausea scores were also significantly lower in the granisetron group
Antiemetic Prophylaxis in Major Gynaecological Surgery With Intravenous Grani...inventionjournals
In a randomized double-blind study, researchers compared the efficacy of granisetron versus metoclopramide for preventing postoperative nausea and vomiting (PONV) in 50 female patients undergoing major gynecological surgery. Patients received either granisetron 40mcg/kg or metoclopramide 0.15mg/kg before surgery. Incidence of PONV was assessed over 24 hours. While both drugs effectively prevented PONV in the first 4 hours, granisetron was more effective over the next 20 hours, with a 12% incidence of PONV versus 48% for metoclopramide. Nausea scores were also significantly lower in the granisetron group
A prospective randomized controlled trial assessing the efficacy of omentopex...Ricky Costa
This study aimed to assess whether attaching the omentum (fatty tissue) to the stomach during laparoscopic sleeve gastrectomy (LSG) surgery could help reduce post-operative gastrointestinal (GI) symptoms like nausea and vomiting. The study involved 60 patients undergoing LSG who were randomly assigned to either have LSG alone or LSG with omentopexy. Patients completed surveys assessing GI symptoms at several time points after surgery. The study found that attaching the omentum did not significantly reduce post-operative GI symptoms or food intolerance compared to LSG alone. Patients with omentopexy did require more anti-nausea medication initially but had no difference in other outcomes. The study concludes that
This study compared the effects of epidural analgesia and patient-controlled analgesia on patients undergoing laparoscopic right colectomy or low anterior resection. The study found that:
1) Epidural analgesia was associated with faster return of bowel function by 1 day in patients undergoing low anterior resection, but not in patients undergoing right colectomy.
2) Epidural analgesia provided significantly better pain control compared to patient-controlled analgesia for both right colectomy and low anterior resection patients.
3) However, epidural analgesia alone was inadequate for pain control in 28% of patients, who required the addition of patient-controlled analgesia.
The document discusses preoperative fasting guidelines and the risks of pulmonary aspiration during surgery. It summarizes a study that compared gastric fluid volume and pH in patients who either fasted overnight or drank 150mL of water 2 hours before surgery. The study found that patients who drank the water had significantly lower gastric fluid volumes (5.5mL vs 17.1mL) after surgery, but similar pH levels. This suggests that allowing clear fluids like water 2 hours before surgery may be safe and help reduce patient discomfort from long fasting times.
Hemodynamic Stress Response of Carbon-Di-Oxide Pneumoperitoneum during Laparo...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
IOSR Journal of Pharmacy (IOSRPHR), www.iosrphr.org, call for paper, research...iosrphr_editor
This study investigated the effects of oral clonidine premedication on hemodynamic changes during laparoscopic cholecystectomy. 100 patients were randomly assigned to receive either oral clonidine 150 micrograms or ranitidine 150 mg 90 minutes before surgery. Heart rate, blood pressure, and the need for antihypertensive treatment were significantly lower in the clonidine group during and after surgery. Postoperative nausea, vomiting, shivering, pain, and sedation were also reduced with clonidine premedication. The results suggest that oral clonidine can provide hemodynamic stability and reduce postoperative complications for patients undergoing laparoscopic cholecystectomy.
Roles of the postanesthesia care unit nurseNick Alfaro
The roles of the PACU nurse include monitoring patients recovering from anesthesia for complications and ensuring safe recovery. PACU nurses must be skilled in airway management, resuscitation, and caring for surgical drains and catheters. Key responsibilities involve assessing vital signs, pain, nausea and other physiological parameters regularly and providing interventions to address issues like hypoxemia and pain. Discharge criteria involves patients being awake, stable, and without active issues like bleeding or hypothermia before leaving the PACU.
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Movement disorders: A complication of chronic hyperglycemia? A case reportApollo Hospitals
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Comparison of Ondansetron and Granisetron for Prevention of Nausea and Vomiting Following Day–Care Abdominal Laparoscopies
1. Comparison of Ondansetron and Granisetron for Prevention of
Nausea and Vomiting Following Day–Care Abdominal
Laparoscopies
2. Original Article
INTRODUCTION
The most distressing symptoms that follow anesthesia
and surgery are pain and vomiting.The syndrome of nausea,
retching and vomiting is known as ‘sickness’ and each part
of it can be distinguished as a separate entity. Sometimes
nausea and vomiting may be so distressing that it can affect
the patient psychologically, physically and financially by a
delay in hospital discharge. With the change in focus from
inpatient to ambulatory anesthesia, there has been an
increased interest in the “Big Little Problem” of nausea and
vomiting [1,2].The etiology and pathophysiology of PONV
are multifactorial with patient, medical and surgery related
factors [3,4]. Three patients related variables i.e. female
gender, smoking and age; 2 operative variables like duration
of surgery, types of surgery (laparoscopic surgery, strabismus
surgery) and 3 anesthesia related variables i.e. use of opioids
intraoperatively, N2O and intravenous anesthesia with
Propofol. Various pharma-cologic agents are rapidly coming
up with increasing efficacy to prevent and treat PONV. The
newer classes of antiemetics are NK-1 (substance P) receptor
antagonists and Serotonin (5-HT3) receptor antagonists (e.g.
Ondansetron,Granisetron,Dolasetron,Tropisetron,etc.)have
replaced the older traditional antiemetics like Phenothiazines
(promethazine), antihistamines (diphenhydramine),
Butyrophenones(drop-eridol),steroids(dexamethasone)and
Benzamides (metoclopramide) because of their side effects
and lesser efficacy [5].
COMPARISON OF ONDANSETRON AND GRANISETRON FOR
PREVENTION OF NAUSEAAND VOMITING FOLLOWING DAY–
CARE ABDOMINAL LAPAROSCOPIES
Ankur Parmar*, V Manjula** and JM Reddy***
*Registrar, Department of Anesthesiology, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi 110 076, India,
**Consultant, ***Senior Consultant, Department of anesthesiology, Apollo Health City,
Jubilee Hills, Hyderabad 500 033, India.
Correspondence to: Dr Ankur Parmar, Registrar, Department of Anesthesiology, Indraprastha Apollo Hospitals,
Sarita Vihar, New Delhi, 110 076, India.
The most common and distressing symptoms, which follow anaesthesia and surgery, are pain and emesis.
The consequences of PONV are physical, surgical and anesthetic complications for patients as well as
financial implications for the hospitals or institutions. Sometimes nausea and vomiting may be more
distressing especially after minor and ambulatory surgery, delaying the hospital discharge. Laparoscopic
surgery is one condition, where risk of PONV is particularly pronounced due to pneumo-peritoneum causing
stimulation of mechanoreceptors in the gut. In spite of plenty of anti-emetic drugs available no single drug is
100% effective in prevention of PNV and combination therapy has got a lot of side effects.
Key words: Ondansetron, Post-anesthesia Vomiting, Granisetron.
Laparoscopy is a technique of minimal invasive
surgery. The hallmark of laparoscopy is the creation of
‘pneumoperi-toneum’ with pressurized CO2 which results
in a high incidence of Post Operative Nausea and
Vomiting (PONV) (40-75% of patients) [6,7].
Laparoscopic procedures are regarded as standard
operations for the study of PONV. The present study was
carried out to examine the incidence of nausea and
vomiting following – laparoscopic cholecystectomy and
compare the efficacy of granisetran Ondansetrom in its
management [8-11].
The aim and objectives
To compare the anti-emetic and anti-nausea effect,
incidence of PONV, duration of action and cost
effectiveness of intravenous Granisetron (1 mg) and
Ondansetron (8 mg) in a randomized double blind study
for prophylaxis of post operative nausea and vomiting
(PONV) in ASA grade I and II adult patients undergoing
abdominal laparoscopies under general anaesthesia.
MATERIALS & METHODS
The study was carried out at Apollo Health City,
Hyderabad from May 2008–October 2009 after obtaining
due institutional approval and informed written consent
from 60 patients.
Apollo Medicine, Vol. 8, No. 2, June 2011 126
3. Original Article
127 Apollo Medicine, Vol. 8, No. 2, June 2011
INCLUSION CRITERIA
(i) Patients ofASAGrade I & II,
(ii) Patients aged between 30-60yrs,
(iii) Patients belonging to either sex,
(iv) Patients weighing between 40-80kg,
(v) Patients scheduled for day care abdominal
laparoscopic surgeries in the surgery department of
the hospital.
EXCLUSION CRITERIA
(i) Patients with any known systemic, metabolic or
endocrine disorder,
(ii) Patients with known allergy to the drugs under study,
(iii) Patients with history of PONV, Gastro esophageal
reflux disease & motion sickness,
(iv) Patients with anticipated airway difficulty,
(v) Uneducated patients who were unable to cooperate
with the investigator.
STUDY TYPE: Prospective, randomized,
comparative, double blinded study.
METHOD
The pre-anesthetic check of the patients was done a
day before surgery. The patients were randomly divided
into two groups using the coin flip method:
• Group A (n=30): IV injection Ondansetron 8mg
diluted in normal saline to a total volume of 5mL
administered 2 minutes before induction.
• Group B (n = 30): IV injection Granisetron diluted in
normal saline to a total volume of 5mL administered
2 minutes before induction.
PREOPERATIVE PREPARATION
All the patients were allowed to take light and non-
residual diet in the evening of previous day of operation.
All of them received tab. Alprazolam 0.5mg and tab.
Ranitidine 150mg orally night before surgery. All the
patients were advised to remain nil per oral after midnight.
ANESTHETIC TECHNIQUE
Study medications were prepared and administered
just 2 minutes before induction by anesthetist in identical
5-mL syringes to ensure blinding.
General anesthesia was induced with inj. Propofol
(1%) 2mg/kg IV, inj. Vecuronium 0.08mg/kg IV and inj.
Fentanyl 100 mcg IV. Endotracheal intubation was done
with appropriate sized cuffed ETT. A nasogastric tube was
placed orally to promote baseline emptying of the
stomach of air and gastric contents.
Maintenance of anesthesia was done with oxygen and
nitrous oxide at the ratio of 1:2, sevoflurane 1% and
intermittent positive pressure ventilation facilitated by
intermittent doses of inj. Vecuronium 1mg IV. The
peritoneal cavity was insufflated with CO2 Pneumo-
peritoneum was established, intraabdominal pressure
maintained around 10-15 mmHg. The IV fluid used during
surgery was 0.9% saline. Pulse, blood pressure,
electrocardiogram, oxygen saturation and end tidal
carbondioxide values were monitored throughout
anesthesia.
At the end of surgery the patients were extubated after
the residual neuromuscular block was reversed with inj.
Neostigmine 0.05mg/kg & inj. Glycopyrrolate 0.02mg /kg
slow IV, and shifted to the recovery room.
OBSERVATIONS
The observations were recorded as per the following
protocol:
1. Pulse rate, blood pressure (BP) and oxygen
saturation (SPO2) were recorded prior to the
induction.
2. Intraoperative pulse, BP, SPO2 and end tidal carbon
dioxide (ETCO2) were recorded throughout the
surgery and the mean was calculated.
3. All the patients were asked for nausea and were
observed for vomiting.
- Every 1 hourly for 2 hours (i.e. at 0, 1st and 2nd
hours)
- Every 2 hourly till 6th hour (i.e. at 4th and 6th
hour)
- At 12th hour then at 24hrs (through phone calls)
4. The incidence of postoperative nausea and vomiting
were scored as per the following scoring system as
proposed by M. Dresner, et al [13].
Postoperative Nausea Score Postoperative
Vomiting score
0–None 0–None
1–Mild intermittent nausea 1–One vomit only
2–Constant modulate nausea 2–Several vomits
3–Severe nausea 3–Repeated retching/
vomiting
4. Original Article
Apollo Medicine, Vol. 8, No. 2, June 2011 128
5. Nausea and vomiting were evaluated by the
following variables: the incidence of nausea and
vomiting, episodes of vomiting, rescue antiemetics,
and complete responses. For the purpose of data
collection, retching (same as vomiting but without
expulsion of gastric content) was considered
vomiting. A vomiting episode was defined as the
events of vomiting that occurred in a rapid sequence
(<1 min between events). If events of vomiting
were separated by >1 min, they were considered
separate episodes.
6. The instruction was given that the patients with >2
episodes of vomiting should receive Inj. Dexa-
methasone (8mg) IV stat as rescue medication [14].
7. The complete response was defined as no nausea, no
vomiting, and no antiemetic medication during a 24-
h postoperative period.
STATISTICALANALYSIS
Data was represented as mean ± standard deviation
wherever applicable. The 2 groups were compared
categorically for nausea and vomiting.A p-value <0.05 was
taken as statistically significant by student’s t-test. The
software used in the study was WINDOSTAT version 8.6.
OBSERVATIONS
Table 1 shows the age, sex & body weight distribution
in the 2 groups of patients. There was no significant
difference in age, sex and body weight distribution in the
two groups.
Table 2 shows the preoperative pulse, blood pressure
(Systolic & diastolic) and SPO2 in the 2 groups of patients.
There was no statistically significant difference in the
baseline values of the patients in the 2 groups.
As per Table 3, none of the cases in the two groups
showed any significant hemodynamic deviation from the
preoperative values in the intraoperative period.
There was statistically no significant difference in the
2 groups in the Table 4, for the type of surgeries which the
patients underwent.
The duration of anesthesia of the patients was
observed in both the groups and the mean value was
calculated for the comparison in each group. There was no
significant difference in the mean duration of anesthesia in
the two groups in the Table 5 (P>0.1).
Figures 1 (a) & 1 (b) show that the patients in group B
did not have nausea in the first 4 hours post operatively
Table 1. Patient demography
Group No. of cases Male(%) Female(%) Age Inyrs. ± Sd Weight in Kg ±Sd
A 30 6 (19.8%) 24 (80.2%) 46.4±9.06 53.0±8.28
B 30 7 (23.3%) 23 (76.7%) 45.7±10.18 54.27±7.77
Table 2. Preoperative pulse, blood pressure & oxygen saturation
Group No. of Pulse Systolic blood Diastolic blood Oxygen saturation
cases (B/M) ± SD pressure pressure SPO2 (%) ± SD
(mm Hg)± SD (mmHg)± SD
A 30 79.53±10.60 123.86±7.99 81.13±4.86 98.83±0.87
B 30 78.86±10.94 121.93±7.94 80.60±5.15 99.23±0.77
Table 3. Intraoperative mean pulse, blood pressure & oxygen saturation
Group No. of Mean pulse Systolic blood Diastolic blood Oxygen saturation
cases (B/M) ± SD pressure pressure SPO2 (%) ± SD
(mm Hg) ± SD (mmHg) ± SD
A 30 79.53±10.61 123.86±7.99 81.13±4.86 100
B 30 78.86±10.94 121.93±7.94 80.60±5.15 100
5. Original Article
129 Apollo Medicine, Vol. 8, No. 2, June 2011
and the incidence of higher scores was also less after 4
hour.
The nausea score in groupA is higher in comparison to
group B. Statistical analysis by student’s t-test indicates
significance at 1 (P=0.027*), 4 (P=0.013*), 6 (P=0.032*),
and 12 hours (P=0.001*) whereas there was no significant
difference observed at 0,2 & 24 hours.
There was no vomiting in group A for first 2 hours and
in group B for the first 12 hours. The vomiting scores
indicated significant statistical difference in vomiting at
12 hours in GroupA(P=0.039*).
Incidence of postoperative nausea & vomiting
In group A patients nausea was observed in 13 patients
(43.33%), vomiting in 12 patients (40%), both nausea &
vomiting in 13 patients (43.33%) & no sickness in 17
patients (56.67%) whereas in group B nausea was
observed in 5 patients(16.67%), vomiting in 2 (6.67%)
cases, both nausea & vomiting in 5 patients (16.67%) & no
sickness in 25 patients (83.33%). Incidence of nausea was
more in group A compared to group B. Incidence of
vomiting was also more in group A. Incidence of sickness
was significantly high in group A. Incidence of no
sickness was significantly more in group B which was
higher than group A (P-value <0.05). It was also observed
that in spite of treatment though incidence of vomiting was
reduced, but nausea was not totally abolished in both the
groups as evident (Figs. 1-6).
DISCUSSION
Postoperative nausea and vomiting are observed after
general, regional and local anesthesia. Reported incidence
of postoperative nausea and vomiting (PONV) after
abdominal laparoscopic surgeries ranges from 40-70%
[6].
The effect of PONV ranges from transient discomfort
to even catastrophic complications like rupture of
esophagus. Other effects are dehydration, electrolyte
disturbances, poor surgical outcome in ophthalmic, head
& neck surgery and abdominal wounds. It limits the
benefit of laparoscopy by delaying hospital discharge and
at times results in an unanticipated overnight admission in
hospital [6].
From the observations of table-1 it was found that
there was no significant difference in age, sex and body
weight (P value >0.1).
In Table 2 and 3, pre-operative and intraoperative
pulse, BP and oxygen saturation of the 2 groups were
studied. The sudden hypotension or hypoxia, which are
positive factor of PONV were not observed. The duration
of anesthesia or the type of surgery done did not show any
marked difference (Table 4 & 5) between the two groups.
The anesthesia time was defined as the time from
anesthetic induction until the patient was shifted to post-
anesthesia care unit.
From observation of the Figure 1 (a) & 1 (b), in Group-
B (Granisetron 1mg) the postoperative nausea score
Table 4. Type of surgery
Group Laparoscopic Laparoscopic Laparoscopic Laparoscopic
cholecystectomy inguinal hernioplasty appendicectomy ventral hernioplasty
GroupA 14(40.67%) 7(2.33%) 7(2.33%) 2(0.67%)
Group B 15(50%) 5(1.67%) 8(2.67%) 2(0.67%)
Table 5. Duration of anesthesia
Group No of Mean duration of
cases anesthesia (min.) ± SD
A 30 78.13 ± 12.11
B 30 77.80 ± 11.24
Table 6. Incidence of postoperative nausea & vomiting
Group No. of cases Nausea Vomiting Total No sickness
A 30 13 (43.33%) 12 (40%) 13 (43.33%) 17 (56.67%)
B 30 5 (16.67%) 2 (6.67%) 5 (16.67%) 25 (83.33%)
6. Original Article
Apollo Medicine, Vol. 8, No. 2, June 2011 130
(a)
(b)
Fig 1. (a) Post operative nausea score – Group A; (b) Post
operative nausea score – Group B
Fig 2. Mean post operative nausea score
(PONS) was significantly lower at 1, 4, 6 and 12 hours
after completion of anesthesia. Post operative vomiting
score (POVS) in Table 6 showed no incidence of vomiting
in patient under Group-B until 12 hours, whereas
vomiting was reported around 4, 6, 12 and 24 hours after
anesthesia in Group A. There was a significant statistical
difference in POVS at 12 hours, P value = 0.034. It shows
that the severity of both nausea and vomiting in the
Granisetron group was significantly less than that in the
Ondansetron group.
From observation in Table 7, response to prophylactic
medication in Group-A and Group-B have shown that 17
(56.67%) and 25 (83.33%) cases remained free from
nausea and vomiting, respectively. The number of cases
who vomited in group B were 2 (6.67%), but it was 12
(40%) case in Group-A. The incidence of nausea in group-
A and B were 13 (43.33%) and 5 (16.67%) cases
respectively. The overall incidence of PONV in Group A
and B were 43.33% and 16.67% respectively. Another
important factor in post-op nausea & vomiting is IV
administration of antibiotics which was not taken into
account in our study.
It has been observed in various studies that antiemetic
therapy is often very effective in reducing incidence of
vomiting or retching, but less so for nausea [17-21].
From the observations in the Table 6, on comparing
the total nausea scores at the end of surgery between group
A and group B it was evident that the duration of
antinausea effect after a single dose of Ondansetron 8mg
was significantly less than that of single dose of
Granisetron 1mg. The nausea score in the Group B was
zero till the end of 4 hours. There was a statistically
significant difference at the end of 1st, 4th, 6th and 12th
hours, with the P values as 0.027, 0.013, 0.032 and 0.001
respectively. Similarly, there were no reported cases of
vomiting in the Granisetron group till the end of 12 hours
which was statistically significant (P = 0.039) when
compared to the vomiting score in the Ondansetron group.
Also, as evident by the higher total scores of nausea and
vomiting in group A, Granisetron 1mg reduces the
severity of nausea and vomiting better than Ondansetron
8mg, the P = 0.003 for total nausea score and P = 0.019 for
Table 7. Total nausea & vomiting score
Group Total nausea score Total vomiting score
(Mean ± SD) (Mean ± SD)
GroupA 1.93 ± 2.74 0.40 ± 0.49
Group B 0.33 ± 0.92 0.13 ± 0.34
P value 0.003 0.019
7. Original Article
131 Apollo Medicine, Vol. 8, No. 2, June 2011
(a) (b)
Fig 3. (a) Post operative vomiting score – Group A; (b) Post operative vomiting score – Group B
Fig 4. Mean post operative vomiting score
Fig 5. PONV incidence in Group A Fig 6. PONV incidence in Group B
total vomiting score comparing both the groups. This
shows that there was a significantly prolonged antinausea
and antiemetic effect with intravenous administration of
Granisetron in the patients undergoing day care abdominal
laparoscopies although there was not a need to administer
the rescue antiemetic or a need of readmission in both the
groups. This implies that the requirement of Granisetron
1mg is twice daily as compared to thrice daily requirement
of Ondansetron 8mg.
Cost is an ever-increasing concern in today’s health
care system. Prophylactic antiemetic with Granisetron is
relatively inexpensive. On comparing the cost of one dose
of inj. Ondansetron 8mg, MRP Rs. 42.00, with one dose of
inj. Granisetron 1mg, MRP Rs. 18.95, it is clearly evident
that the therapy of PONV with Granisetron per dose is
8. Original Article
Apollo Medicine, Vol. 8, No. 2, June 2011 132
approximately 2.21 times cheaper than the treatment with
Ondansetron.
PONV can lead to a number of unwanted side effects
including fluid and electrolyte imbalance, wound
dehiscence, delayed discharge of day care patients, unanti-
cipated hospitalization of day care patients with extra
costs to the patient and the hospital. Increasingly there is a
trend towards day care surgery therefore these last two
factors have become important considerations. PONV can
lead to a lot of stress for the patient, their relatives and
health workers and create major negative impact on
patient satisfaction and overall surgical experience.
CONCLUSION
From the present study, it was concluded that-
• There was no significant hemodynamic difference in
the patients receiving Ondansetron or Granisetron.
• The patients who received Granisetron had signi-
ficantly less severe Post Operative Nausea compared
to the group that received Ondansetron.
• There was a decrease in the incidence of post
operative nausea in the patients receiving
Granisetron as compared to Ondansetron.
• The incidence of post operative vomiting was
significantly less with Granisetron than with
Ondansetron.
• The duration of action of Granisetron was longer
than Ondansetron even when administered at the
start of anesthesia, as evident by the post operative
nausea and vomiting scores.
• The cost effectiveness of the therapy of PONV was
significantly more with Granisetron than with
Ondansetron.
Hence, Granisetron can be used as an antiemetic agent
in abdominal laparoscopic surgeries to reduce the
incidence of postoperative nausea & vomiting.
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