Anesthesia Research, Helsinki University Central Hospital, Finland.
Title
Recovery profile after desflurane with or without ondansetron compared
with
propofol in patients undergoing outpatient gynecological laparoscopy.
Source
Anesthesia & Analgesia. 82(3):533-8, 1996 Mar.
Abstract
We studied the effect of combining prophylactic ondansetron (4 mg
intravenously [IV]) to desflurane-based anesthesia in 90 ASA grade I or 11
women undergoing outpatient gynecological laparoscopy. Recovery after
anesthesia, with special focus on postoperative nausea and vomiting (PONV),
was assessed. Control groups received a similar desflurane anesthetic
(placebo) or a propofol-infusion-based (active control) anesthetic. The
study design was randomized, controlled, and double-blind (regarding
ondansetron) and single-blind (regarding the anesthetic technique). Early
recovery (eye opening, orientation, following commands, sitting) was similar
in the three groups. However, overall home readiness (toleration of oral
fluids, walking, pain tolerable by oral analgesics, no or only mild nausea)
was achieved faster in the desflurane group receiving ondansetron (109
[21-937] min, P < 0.01) and in the propofol group (110 [33-642] min, P
< 0.001) when compared to the desflurane only group (372 [45-723] min)
(median [range]). The total incidence of PONV in the desflurane-only group
was 80% (P < 0.01), compared to 40% and 20% in the desflurane group
receiving ondansetron and the propofol group, respectively. The
postoperative antiemetic requirements were consistently and significantly (P
< 0.01) higher in the desflurane-only group compared to the other two
groups. Postoperative sedation, analgesic requirements, and psychomotor
recovery (assessed by the Maddox Wing and the Digit Symbol Substitution
Tests) were similar in the three groups. Our results suggest that in order
to achieve a propofol-like recovery profile in patients with a high
likelihood of PONV, desflurane should be combined with a potent antiemetic
(e.g., ondansetron).