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

Intravenous droperidol decreases nausea and vomiting after alfentanil anesthesia without increasing recovery time.

The frequency rate of nausea and vomiting after an alfentanil-based anesthetic is high, with reported frequencies of 38% to 68%. This study was undert...
576KB Sizes 0 Downloads 0 Views