Effect of Anti-Emetic Combination of Sevoflurane / Propofol Anesthesia Technique in Laparoscopic Cholecystectomy
DOI:
https://doi.org/10.51985/JBUMDC2021046Keywords:
Propofol, Nausea, Laproscopic cholecystectomy, SevofluraneAbstract
Objective: To assess symptoms of nausea and vomiting in laparoscopic cholecystectomy post-operatively, administered
anesthesia by sevoflurane or propofol and to assess the effect of dexamethasone and ondansetron anti-emetic combination.
Study design & Setting: It was an experimental study design conducted from 08-Oct-2017 till 11-Jul-2018 at Rawal
General & Dental Hospital.
Methodology: Patients were recruited in interventional groups by lottery method as n=160, with 80 cases allocated in each
group. The patients with gallstones planned for laparoscopic cholecystectomy after preoperative assessment were classified
to American Society of Anesthesiologist (ASA) physical status class I-II. All the patients placed in a particular ASA physical
status class were (exposed to both induction methods) either anesthetic induction by propofol 1-2 mg/kg (group-A) or by
employing sevoflurane 4-8% (group-B) in combination with oxygen, while maintenance was done in both study groups
with 2% sevoflurane and 50% nitrous oxide in oxygen. After procedure patients stayed in post-anesthesia care unit where
intra-operative monitoring was evaluated. The primary end point of the study was to note the rate of nausea and vomiting
in 24 hours interval after surgery.
Results: Both sevoflurane and propofol are equally effective anesthetic induction agents. The same combination of
dexamethasone and ondansetron was given to both groups and so the actual effect of both anesthesia drugs in terms of side
effects were nullified.
Conclusion: In laparoscopic cholecystectomy, both sevoflurane and propofol are good enough when administered with
dexamethasone and ondansetron anti-emetic combination, for post-operative nausea and vomiting up to 24 hours observation
time in study.
References
Di Buono G, Romano G, Galia M, Amato G, Maienza E,
Vernuccio F, Bonventre G, Gulotta L, Buscemi S, Agrusa A.
Difficult laparoscopic cholecystectomy and preoperative
predictive factors. Sci Rep. 2021;11(1):2559. https://doi.org/
1038 /s41598-021-81938-6.
Majumder A, Altieri MS, Brunt LM. How do I do it:
laparoscopic cholecystectomy. Ann Laparosc Endosc Surg
: 5;5766. https://doi:10.21037/ales.2020.02.06
Hsieh CY, Poon YY, Ke TY, Chiang MH, Li YY, Tsai PN,
Wu SC. Postoperative Vomiting Following Laparoscopic
Cholecystectomy Is Associated with Intraoperative Fluid
Administration: A Retrospective Cohort Study. Int. J. Environ.
Res. Public Health 2021, 18, 5305. https://doi.org/ 10.3390/
ijerph18105305
Sikka PK, Beaman ST, Street JA. Basic Clinical Anesthesia.
Springer 2015; (II):123-65.
Farda W, Tani M.K, Manning RG, Fahmi MS, Barai N et al.
Laparoscopic cholecystectomy: review of 1430 cases in Cure
International Hospital, Kabul, Afghanistan. BMC Surg
:21; 344. https://doi.org/10.1186/s12893-021-01342-9
Zackria R, Lopez RA. Postcholecystectomy Syndrome. 2021
Sep 2. In: StatPearls [Internet]. Treasure Island (FL): StatPearls
Publishing; 2021 Jan–. PMID: 30969724.
Liu Q, Zhou C, Bao Z, Zhu Y. Effects of palonosetron and
ondansetron on preventing nausea and vomiting after
laparoscopic surgery. J Int Med Res. 2018;46(1):411-420.
https://doi:10.1177/0300060517715374.
Maqbool MS, Alam M, Ayesha. Post-Operative Recovery
Profile after Laproscopic Cholecystectomy: Comparing
Inhalational Versus Intravenous Anaesthetic Regimen. JRMC
;23(1):38-42.
Maqbool MS, Alam M, Draz MU, Shahid A, Ashfaq S.
Anaesthesia Concern in High-Risk Cases Under Going
Ambulatory Laparoscopic Cholecystectomy. J Bahria Uni
Med Dental Coll. 2021; 11(4):179-183. https://doi.org/ 10.
/JBUMDC2021045
Fredman B, Nathanson MH, Smith I, Wang J, Klein K,White
PF.Sevoflurane for outpatient anesthesia: a comparison with
propofol.Anesth Analg 1995;81:823-8. https://doi:10.1097
/00000539-199510000-00028.
Morgan GE, Mikhail MS.Clinical Anesthesiology.5th
Edition.McGraw Hill Education 2013;18:297.
Manzia TM, Quaranta C, Filingeri V, Toti L, Anselmo A, et
al. Feasibility and cost effectiveness of ambulatory laparoscopic
cholecystectomy. A retrospective cohort study. Ann Med Surg.
; 55:56-61. https://doi.org/10.1016/j.amsu. 2020.04.036.
Nadri S, Karimi A, Mohammadi F, Mahmoudvand H. A
randomized controlled trial evaluating inhalation and
intravenous anesthesia for laparoscopic cholecystectomy. Int.
J. of Surg. Open 2021;28:1-7. https://doi.org/ 10.1016/j.ijso.
12.001.
Ababneh OA, Suleiman AM, Bsisu IK, Al-Ghanem SM,
Samarah WK, Al-Zaben KR, Qudaisat IY, Khreesha LA, Al
Edwan GM, Murshidi MM. A Co-Induction Technique
Utilizing 4% Sevoflurane Followed by 0.75 mg/kg Propofol
in Elderly Patients Undergoing Minimally Invasive Procedures:
A Prospective Randomized Control Study. Medicina (Kaunas).
;56(12):682. https://doi.org/10.3390 /medicina56120682.
Nagalakshmi P, Leo S, Uthirapathi S. Use of Butorphanol,
Fentanyl, and Ketamine as Co-Induction Agents with Propofol
for Laryngeal Mask Airway Insertion: A Comparative Study.
Anesth Essays Res. 2018;12(3):729-734. https://doi.org/
4103/aer.AER_104_18.
Matsuura H, Inoue S, Kawaguchi M. The risk of postoperative
nausea and vomiting between surgical patients received
propofol and sevoflurane anesthesia: A matched study. Acta
Anaesthesiol Taiwan. 2016;54(4):114-120. https://doi:
1016/j.aat.2016.09.002.
Bernardo, S, Vieira, A, Vieira, V 2018 Challenging the
Anaesthetic Technique for Laparoscopic Cholecystectomy in
Ambulatory Surgery. Ambul 2017; 12:94-97.
Sharma S, Gnanasekar N, Kurhekar P. Comparison of
dexamethasone, granisetron and haloperidol in prevention of
postoperative nausea and vomiting following laparoscopic
surgeries: A prospective, double-blinded study. Glob J Anesth
;6(1):2-5. http://doi.org/10.17352/2455-3476.000045
Gautam B, Shrestha BR, Lama P, Rai S. Antiemetic prophylaxis
against postoperative nausea and vomiting with ondansetrondexamethasone combination compared to ondansetron or
dexamethasone alone for patients undergoing laparoscopic
cholecystectomy. Kathmandu Univ Med J 2008;6(23):319-
https://doi: 10.3126/kumj. v6i3.1706.
Yu WY, Li QJ, Wui CX, Gong JP. The Prophylaxis and
Treatment with Ondansetron for Postoperative Nausea and
Vomiting. Surg Curr Res 2015; 5:224. https://doi:10.4172/2161-
1000224
Jin Z, Gan TJ, Bergese SD. Prevention and Treatment of
Postoperative Nausea and Vomiting (PONV): A Review of
Current Recommendations and Emerging Therapies. Ther
Clin Risk Manag. 2020 31; 16:1305-1317. https://doi
2147/TCRM.S256234.
Elvir-Lazo OL, White PF, Yumul R and Cruz Eng H.
Management strategies for the treatment and prevention of
postoperative/postdischarge nausea and vomiting: an updated
review F1000Research 2020; 9:983. https://doi.org/10.
/f1000research.21832.1
Ahsan K, Abbas N, Naqvi SM, Murtaza G, Tariq S. Comparison
of efficacy of ondansetron and dexamethasone combination
and ondansetron alone in preventing postoperative nausea
and vomiting after laparoscopic cholecystectomy. J Pak Med
Assoc. 2014 Mar 1;64(3):242-6.
Maqbool MS, Alam M, Draz MU, Shahid A, Ashfaq S.
Anaesthesia Concern in High-Risk Cases Under-Going
Ambulatory Laparoscopic Cholecystectomy. J Bahria Uni
Med Dental Coll. 2021; 11(4):179-183. https://doi.org
/10.51985/JBUMDC2021045
Si XY, Wu LP, Li XD, Li B, Zhou YM. Dexamethasone
combined with other antiemetics for prophylaxis after
laparoscopic cholecystectomy. Asian J Surg. 2015;38(1):21-
https://doi: 10.1016/j.asjsur.2014.04.005.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2021 Muhammad Salman Maqbool, Muhammad Alam, Muhammad Umer Draz, Ayesha Shahid, Shumaila Ashfaq
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Journal of Bahria University Medical & Dental College is an open access journal and is licensed under CC BY-NC 4.0. which permits unrestricted non commercial use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this license, visit https://creativecommons.org/licenses/by-nc/4.0