Effect of low-dose droperidol on postoperative anxiety, tension, overall mood and PONV

Background: Droperidol even in low doses such as 0,5 mg to 1,25 mg can incr ease postoperative anxiety and state of tension. The aim of this study was to determine whether these side effects occur frequently following low-dose droperidol and to see whether these are dose related. Methods: 184 female in- and outpatients ASA grade 1 and 2 undergoing gynaec ological laparoscopy were recruited to this prospective, double-blind study . General anaesthesia was standardized (induction with thiopentone, fentany l 2 mu g/kg and vecuronium 0,1 mg/kg,tracheal intubation, maintainance with enflurane in N2O/O-2). Patients were randomly allocated to receive saline (n=45), 0,625 mg (n=46), 1,25 mg (n=47) or 2,5 mg (n=46) droperidol i.v. 10 minutes before the end of surgery. 1, 3, 6, and 24 hours postoperatively, the patients' anxiety, state of tension and overall mood was evaluated usin g two psychological questionnaires which had been tested for the perioperat ive period (Erlanger anxiety and tension-scale/BSKE-EWL-test). Sedation was evaluated by the staff of the recovery room. In addition, postoperative na usea and vomiting (PONV) was assessed using a 100 mm visual analogue scale and by counting the episodes of retching or vomiting. PONV was then rated o ver the whole observation period as none, mild, moderate or severe using a fixed scoring algorithm. Statistical analysis was performed using the ANOVA and the chi(2)-test. Results: The patients did not differ with regard to biometric data,duration of surgery and anaesthesia. The postoperative scores for anxiety, state of tension and overall mood were not different between the groups at any obse rvation time (Fig. 1:anxiety and tension: P=0,5687; figure 2: overall mood: P=0,0647). Quality of sleep in the first night after surgery was the same in all groups (Table 2 and 3). Sedation was not significantly different (Ta ble 4; P=0,0704). Furthermore, duration of stay in the recovery room did no t differ (P=0,4353). On the other hand, three patients from the 2,5 mg drop eridol group had to stay unexpectedly on the ward overnight, because they h ad been too much sedated to be discharged at home. This was not the case wi th any patient from the other groups. Compared to placebo, PONV over the wh ole 24 h observation period was significantly reduced by droperidol (Fig. 3 ; P=0,0338): completely free from PONV: placebo: 41,3%, 0,625 mg droperidol : 67,4%, 1,25 mg droperidol: 53,2%, 2,5 mg droperidol: 71,7%. Also the seve rity of PONV was reduced. Conclusion: In gynaecological laparoscopy under general anaesthesia with tr acheal intubation,we recommend droperidol 0,625 mg in the prevention of PON V, as it reduces PONV as well as 2,5 mg with no severe sedation in this dos age. Psychological side effects did not occur more frequently after droperi dol compared to placebo in any of the investigated dosages.