Intravenous Droperidol Decreases Nausea and Vomiting after Alfentanil Anesthesia without Increasing Recovery Time Nathan H. Jorgensen, MD,* Joseph P. Coyle, MD-F 1)eparttnent
of’ Anesthesiology,
The freyueucy high,
rate of riausea
zuith reported
e-ilaluate fretjuenty
*Anesthesiology Fellow, Department of Anesthesiology, Bethesda Naval Hospital tAnesthesiologist and Critical Care Physician, Department of Anesthesiology, Charlotte Memorial Hospital, Charlotte, NC
Sixty norhal req&ing
generul
or (3) droperidol the study drug anesthesia
‘l‘his work was done at Bethesda Naval Hospital during February to June 1988. The opinions expressed herein are those of the authors and not necessarily those of the Department of the Navy or the Department of Defense. This work was presented in part at the 63rd Congress of the International Anesthesia Research Society in Lake Buena Vista, Florida, March 8, 1989. Received for publication Derember 20, 1989; revised manuscript accepted for publication May 10, 1990.
J. Clin. Anesth.,
uomitivg
vol.
in decreasit~g
A stundard
was given
immediately
room, all patients
ulfen tan&ba.sed
to undeqo
short
randomly
to the
procedur1J.s
in a double-blind
vnan?let’ to
(2) droperidol
aJfentanil-ba_sed after
induction
were esaluated
ane.sthetic
wm
of arlesthe.sia.
according
a score oj’ IO. Presence
or absence
To assets psychomotor
recovery,
were noted.
a tlesthetic.
.surgical
sc~linu;
preopevati-r~ely, at the time oj
10 Fglkg; usd,
and
Irr the @t-
IO the Aldrete .scor~,
and severity of nausea IL
‘Trigger dot te.st w(L.\ Aldrete .score of IO,
performed
by euevy put&t
and @on
discharge from the relouevy room. There wus no .statisticat dif;fprence
nn
between the ,~r~~p.s in age, .sex, type oi procedure, weight, total dose of’a~fontavril, or duration of unesthetic. The frequency
oJ‘nausea arxt vomiting ZMSsi,~vLficantJv
1e.s.s(p < 0.05) fwr the 20 pglkg group (5%)) than,for the 10 kglkg gv-oup (25 $6) or the control g-rouj.~ (40%). A dose-response t.elationshij~ was eGdettt 101. thu antipmetic fffect oj droperidol. An analog scaleJ& .se-i~erifyof‘nuuseu und zlotniting also demonstrated u dose response effect. The time to nn Aldrete .score of 10 Ural the time to dischurge,from the recou&
room were not ~tatistirally diff>rerrt between
the groups. Trieger dot scores, used to evaluate recol)eT of psvchomotov- .skill.,, did not demonstrate
(1 statistical
that droperidol
Cg&n during
zlomiting in a dose-dependent
dif]i?rence
between
a~fmtanil-based manner
the groups.
anesthe.siu
and ha,s no apparent
The
conclusions
2, September/October
lYY0
art>
does f>rezlevt,t rtousea und effect ot1 t-ec,o-ilety from
anesthesia.
Keywords: Anesthesia, intravenous; alfentanil; vomiting; recovery period, anesthesia.
0 1990 Butterworth-Heinemann
312
and
study WLS undertakplr
droperidol
a standard
(I) control-norvnul
20 kgikg.
recoueq
after
were assigned
of 20:
tlotillg the time to achieve Address reprint requests to Dr. Coyle at the Department of Anesthesiology, Charlotte Memorial Hospital, P.O. Box 32861, Charlotte, NC 2X236, USA.
recoue?
who were sche&Gd
anesthe.sia
one of three groups
to 68%). 7%
and moderate-dose
nauseu and -immiting and to e-ilaluate whether droperidol
on .slowing adults
of 36%
of low-dose
of p 0s:t opera&e
has any effect
and z)omiting afier an ayPntcLnil-(,cr.Fucler~t(Lriil-~~~L.se(l anesthf&c. is
frequenries
the efficacy
Naval Hospital, Kethesda, MI).
Bethesda
droperidol;
nausea;
Introduction Alfentanil, a short-acting opioid, would seem to be particularly suitable for short-duration outpatient procedures. It combines a short duration of action with a hemodynamic profile of cardiovascular stability. I -Y An important drawback in the outpatient setting is a high occurrence rate of nausea (45% to 68%) and vomiting (38%)1 reported with the use of alfentanil. Droperidol is an effective antiemetic in a variety of doses for the management of postoperative nausea and vomitingY Early studies with alfentanil showed that the concomitant use of droperidol was associated with a lower frequency of nausea and vomiting in the recovery roonl.Y.!’ ‘I’hese studies, however, were not specifically designed or controlled for studying the antiemetic effects of droperidol and, therefore, did not address the issue of dose. Droperidol has the potential to prolong recovery from anesthesia and in so doing negates one of the advantages of alfentanil in the outpatient setting.Y,“.‘O ‘l-he purpose of this study was to determine the effect of two standard doses ( 10 kg/kg and 20 pg/kg) of droperidol on postoperative nausea and vomiting when given during an alfentanilbased anesthetic and to assess whether droperidol affects etnergence and recovery of psychomotor skills.
Materials and Methods After approval of’the study was granted by the Commtitee for the Protection of Human Subjects at Bethesda Naval Hospital, written informed consent was obtained from 60 normal adults (ASA physical status I or II) scheduled to undergo short surgical procedures requiring general anesthesia. The patients were assigned randomly in a double-blind manner to three groups of 20 patients each: group 1 = control-normal saline; group 2 = droperidol 10 kg/kg; group Z1 = droperidol 20 kg/kg. All study solutions were prepared and randomized by the hospital pharmacy in identical volumes. Anesthetic induction consisted of vecuronium 10 pgikg, thiopental sodium 3 to 5 mgi kg, alfentanil 25 pg/kg, and succinylcholine 1.5 mgi kg to facilitate intubation. Anesthesia was maintained with :-SO%oxygen (0,) and ‘70% nitrous oxide (NY