European Journal of Molecular & Clinical Medicine

Back ground: When prophylaxis is not used, ENT operations have a significant incidence of postoperative emesis. Antiemetic use as a preventative measure may lower total PONV-related resource use and expenses, improving patient satisfaction. Numerous methods have been employed to reduce the incidence of PONV such as pharmacological interventions for prophylaxis, altering the anaesthetic technique, or combining them all for optimum protection. The present study was conducted with an aim to compare the effectiveness between propofol and dexamethasone in the prevention of postoperative nausea and vomiting after ear, nose and throat surgery and to study any adverse effects associated with these drugs.
Materials and methods: A total of 60 patients who underwent ENT surgeries were divided into two groups with 30 in each group. Group A received dexamethasone 8mg and Group B received propofol 0.5mg/kg after completion of surgery. The incidence and severity of PONV and associated adverse effects were documented at immediate post-op, 30 minutes, 1^{st -}, 6^{th -} , 12^{th -} , and 24^th- hour after the administration of study drug. In addition, the requirement of rescue antiemetics in the overall 24 hours was documented.
Results: There was no statistically significant difference between the dexamethasone and propofol groups in terms of age, gender, body mass index (BMI), type of surgery, ASA status, or duration of anaesthesia and surgery. Incidence of severe PONV (3.3% versus 12%, p =0.008) were statistically significantly lower in group A compared to patients in group B over the 6th-12thhour time period. The mean time to first nausea episode in group A was significantly more compared to group B (p<0.001).
Conclusions: Although the efficacy of dexamethasone and propofol in preventing post-operative nausea and vomiting in ENT surgeries are comparable dexamethasone produced better PONV protection than propofol.

Background: Emergence agitation has potential to harm both patients and caregivers. This is more often witnessed in patient undergoing otolaryngology operations under general anesthesia with volatile anesthetic used for maintenance.
Aim: We investigated the effects of intra-operative dexmedetomidine infusion on emergence agitation and quality of recovery after functional endoscopic sinus surgery in adult patients.
Materials and Methods: One hundred patients undergoing functional endoscopic sinus surgery were randomized into two groups. The dexmedetomidine group (Group D, n = 50) received dexmedetomidine infusion at a rate of 0.4 mcg/kg/hr from induction of anaesthesia until extubation, while the control group (Group C, n = 50) received volume-matched normal saline infusion as placebo. Propofol (2 mg/kg) and fentanyl (2 mcg/kg) were used for induction of anaesthesia, and sevoflurane was used for maintenance of anaesthesia. The incidence of agitation, haemodynamic parameters, and recovery characteristics were evaluated during emergence. A 40-item quality-of-recovery questionnaire (QoR-40) was provided to patients 24 hours after surgery.
Results: The incidence of agitation was lower in Group D than Group C (28 vs 56 %, P = 0.018). Mean arterial pressure and heart rate were more stable intra-operatively and during emergence in Group D than in Group C (P < 0.05). Time to extubation, nausea and vomiting, and pain scores were similar between the groups. Global QoR-40 score at 24 hours after surgery was higher in Group D (mean 174.7 ± 6.99) compared with Group C (mean 169.4 ± 9.91) (P < 0.05).
Conclusion: Intra-operative infusion of dexmedetomidine provided smooth and hemodynamically stable emergence. It also improved quality of recovery after nasal surgery.

Background: The goal of PONV management is to reduce or eliminate PONV and discomfort with minimum side effects. 5-HT antagonists work by blocking one of the pathways that lead to vomiting. Ondansetron is the most commonly used drug for this purpose. Ramosetron has a higher affinity for the 5-HT3 receptor than the older 5-HT3 antagonists, with an optimal dose of 0.6 mg and maintains its effects over two days.
Objectives: To compare the efficacy of ondansetron and ramosetron in the control of
postoperative nausea and vomiting and to determine the occurrence of adverse effects with ondansetron and ramosetron.
Material and Methods: Fifty patients aged between 20-60 years posted for lower abdominal surgeries were divided into two groups (Group A & Group B) on the basis of the random sampling method. Group A received the first dose of Ramosetron in the intraoperative period 30min-1 hour before expected end of surgery. Group B received the first dose of Ondansetron in the intraoperative period 30min-1 hour before the expected end of surgery. Both groups were postoperatively monitored for incidence of nausea, the severity of nausea, the incidence of vomiting and use of rescue antiemetics, for 24 hours.
Data Analysis: The mean and Standard Deviation (SD) in each group was calculated. The data were analyzed by student t-test. For qualitative data, Chi-Square test was used for analysis. P-value less than 0.05 was considered statistically significant.
Result: The present results revealed that ramosetron is more effective than ondansetron in preventing late postoperative nausea and vomiting. Ramosetron is more potent and longer acting as compared to ondansetron. Incidences of side effects and use of rescue antiemetic are statistically not significant in both the groups.
Conclusion: This study concludes that the prophylactic intravenous administration of
ramosetron is more effective than ondansetron for controlling late postoperative nausea and vomiting.