EFFECT OF PROPOFOL FOR INDUCTION AND ONDANSETRON WITH OR WITHOUT DEXAMETHASONE FOR THE PREVENTION OF NAUSEA AND VOMITING AFTER MAJOR GYNECOLOGIC SURGERY

Study Objectives: To test the hypothesis that for major gynecologic su rgery the combination of propofol for induction, ondansetron, and dexa methasone would be a more effective antiemetic combination than propof ol for induction, ondansetron, and saline; and to determine if a propo fol induction of anesthesia improved our previously reported results w hen thiamylal was the induction drug. Design: Double-blind, randomized study. Setting: Magee-Womens Hospital, Pittsburgh, Pennsylvania. Pati ents: 80 healthy ASA physical status I, II, and III female inpatients scheduled for major gynecologic surgery. Interventions: After inductio n of anesthesia with propofol, Group 1 received intravenous (IV) ondan setron 4 mg and saline, and Group 2 received IV ondansetron 4 mg follo wed by IV dexamethasone 20 mg. Measurements and Main Results: For Grou p 1 and Group 2, respectively, no emesis and no rescue occurred in 15 (37.5%) and 21 (52.5%) patients (p = 0.13); emesis occurred in 7 (17.5 %) Group 1 patients and 5 (12.5%) Group 2 patients, rescue antiemetic 23 (57.5%) Group 1 patients and 19 (47.5%) Group 2 patients. Nausea wa s reported by 31 (77.5%) Group I patients and 30 (75%) Group 2 patient s. Conclusions: The hypothesis that the addition of dexamethasone to t he propofolondansetron combination would significantly reduce postoper ative nausea and vomiting (PONV) was not confirmed. A propofol inducti on of anesthesia resulted in a comparable incidence of PONV when compa red with our previously reported results using thiamylal for induction of anesthesia for women having major gynecologic operations. (C) 1997 Elsevier Science Inc.