Preventive Efficiency Of Ramosetron For Postoperative Nausea And Vomiting With Different Administrations

There is no doubt that the future medical services will advance for patients'safety and comfort. Anesthesiology will naturally become one of the most important academic subjects in the "Comfortable Medical Treatment" system. Anesthetists are not only the guardians for peri-operative safety, but also the people who would make patients comfortable postoperatively. Many clinical surveys show that pain, nausea and vomiting are all common complications after surgery; postoperative nausea and vomiting (PONV) may be even more severe than postoperative pain. Now, many kinds of drugs are being used for prevention of PONV, of which the most widely used one is 5-HT3 receptor antagonist. Most of the papers focused on PONV are about the comparison of antiemetic efficiency with different drugs, there is no consensus on the administration mode. The subjects of this study are patients undergoing under laparoscopic cholecystectomy general anesthesia, which have a higher incidence of PONV. The purpose is to explore a rational antiemetic method on the basis of meeting patient's requirement of pain-free.Objective: To explore a rational administration mode of ramosetron in order to prevent postoperative nausea and vomiting after general anesthesia in laparoscopic cholecystectomy.Methods: One hundred and twenty ASA II–III patients undergoing laparoscopic cholecystec- tomy under general anesthesia, aging from 20 to 70 years old and weighing from 45 kg to 70 kg, were randomly divided into 6 groups: C (the control group);Ⅰ(ramosetron 0.3mg iv, 5 minutes before anesthesia);Ⅱ(ramosetron 0.3mg iv when skin was sutured); III(ramosetron 0.3mg administrated in the analgesic pump);Ⅳ(ramosetron 0.3mg iv 5 minutes before anesthesia,and ramosetron 0.3mg administrated in the analgesia pump); V (ramosetron 0.3 mg iv when skin was sutured, and ramosetron 0.3 mg administrated in the analgesia pump). Patients in each group use analgesia pump voluntarily,and the analgesic drug in the pump is sufentanil (2.0 g/kg). Patients were routinely monitored and upper extremity venous access was opened. Premedication penehyclidine hydrochloride 1 mg was administrated 15 minutes before anesthesia. Induction of anesthesia: midazolam 0.05 mg/kg, propofol 1-2 mg/kg, vecuronium 0.15 mg/kg, sufentanil 0.5 g/kg, and then endotracheal intubation was performed followed by mechanical ventilation. Parameters: tidal volume (VT) 8-10 ml/kg, respiratory rate (RR) 12-18 /min, inspiratory to expiratory ratio (I / E) 1:2. During the operation, PETCO2 was maintained between 35 and 40 mmHg by adjusting VT or RR, and the MAC of sevoflurane was monitored. Maintenance of anesthesia: Inhalation of 2% -3% sevoflurane, MAC between 1.2-1.5, no more sufentanil, on-demand intravenous propofol and vecuronium. Sevoflurane was stopped when surgery was over, neostigmine 1mg and atropine 0.5mg to antagonize the residual muscle relaxants when spontaneous breathing resumed. Extubation indication was VT>5ml/kg with Spo2>95%. Patients were sent back to ICU with analgesia pump connected to the venous access. Incidence of PONV and scores of patient's satisfaction and VAS were observed then recorded.Results: Incidence of PONV in 5 experimental groups were all lower than the control group; GroupⅣand V had significant difference (P <0.05) compared with group C at 48 hours postoperatively, while groupⅠwas significantly different from group C only at T1; Among experimental groups, groupⅢwas significantly different fromⅠandⅣonly at T1.There were no significant differences at different time in each group. Satisfactory degree:Scores of experimental groups were all higher than the control group, andⅠ,Ⅳ, V had significant differences (P <0.05) with group C, and only groupⅣ's average≥3 points; Among experimental groups, groupⅢhad the lowest score and was significantly different from groupⅣ. There were no significant differences among 6 groups in VAS and adverse reactions.Conclusion:1 Ramosetron can effectively prevent PONV of patients undergoing laparoscopic cholecystectomy with postoperative analgesia in parallel.2 Ramosetron 0.3mg administrated before anesthesia can significantly prevent early PONV and improve satisfactory degree of patients undergoing laparoscopic cholecystectomy with postoperative analgesia in parallel.3 Ramosetron 0.3mg iv before anesthesia combined ramosetron 0.3mg administrated in the analgesia pump can not only make scores' average≥3 points, but also significantly prevent early and later PONV of patients undergoing laparoscopic cholecystectomy with postoperative analgesia in parallel.