Prophylaxis of nausea and vomiting after pelviscopy. Dolasetron or MCP in comparison with placedo

Background: Gynaecological surgery including laparoscopy is frequently asso ciated with PONV. Therefore, choosing an anaesthetic with only little side effects in operations eligible for outpatient surgery is at least as import ant as applying anaesthetics that enable fast-tracking. Study goal: To asse ss the incidence and severity of PONV after balanced desflurane-N2O-anaesth esia and to compare the antiemetic efficacy of dolasetron or metoclopramide versus placebo. Methods: 120 ASA physical status I and ii women aged 18 to 55 scheduled for elective laparoscopic surgery were enrolled. Anaesthesia was standardized: fentanyl (2 mu g/kg), etomidate (0.25 mg/kg) and succinylcholine (1 mg/kg)f or induction and desflurane 3-5% et along with 30% O-2 in N2O, fentanyl (ma x. 0.1 mg/h) and cis-atracurium for maintenance. Patients were randomly all ocated to receive one of the following: dolasetron 12.5 mg (group-D), metoc lopramide 10 mg (group-M) or placebo (group-P). Results: Within the first 24 h, postoperative nausea (PON) and postoperativ e vomiting (POV) were reduced significantly in group D (38%/19%) and group M (36%/27%) compared to group P (69%/56%). Furthermore, PON and POV proved to be less intense in groups D and -M compared to group P: Episodes of seve re nausea were recorded 17 times in 10 patients (17/10) in group P,compared to 5/4 in group M and 5/3 in group D, episodes of repeated Vomiting 13 tim es in 8 patients (13/8) in group P, compared to 2/2 in group M and 2/1 in g roup D. Conclusions: Our results confirm the increased incidence of PONV after gyna ecological laparoscopic surgery under balanced anaesthesia compared to the predicted rates. Both dolasetron and metoclopramide proved to be effective prophylactic measures. Given a PONV-incidence of 38% in group 0 and 39% in group M, it is doubtful, whether the anaesthetic technique chosen in this s tudy is the most suitable regimen for ambulatory gynaecological laparoscopi es.