Minimum Effective dose of Dexamethasone in ...

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Original Article

Minimum Effective dose of Dexamethasone in Combination with Midazolam as Prophylaxis against Postoperative Nausea and Vomiting after Laparoscopic Cholecystectomy Rakhi Gupta, Shashi Srivastava1, Sanjay Dhiraaj1, Puja P Chovatiya2 Department of Anaesthesia and Pain Medicine, Hind Institute of Medical Sciences, 1Department of Anaesthesia, Sanjay Gandhi Postgraduate Institute of Medical Sciences, 2Department of Anaesthesia, Javitri Hospital, Lucknow, Uttar Pradesh, India

Abstract Background: Postoperative nausea and vomiting (PONV) affects 20% and 30% of patients. As many as 60%–80% patients at high risk may be affected. Dexamethasone (D) and midazolam (M) are well studied as antiemetic. Use of D can be associated with certain undesirable side effects so minimum dose is preferred. M is a routinely used premedicant. Hence, this study was designed with both D and M in high risk patients for PONV to find minimum effective dose of D. Aims: To determine the minimum dose of D that combined with M would provide effective prophylaxis of PONV after laparoscopic cholecystectomy (LC) in patients at high risk for PONV. Setting and Design: This is a prospective, randomized double‑blind trial. Materials and Methods: One hundred and fifty‑five patients scheduled for elective LC were randomized to 5 groups of 31 each. Group C was given normal saline, and the rest were administered D 1 mg (group MD1), 2 mg (group MD2), 4 mg (group MD4), or 8 mg (group MD8) in combination with 0.04 mg/kg M at induction. The incidence of nausea, vomiting, severity of nausea, and the use of rescue antiemetic and postoperative pain was analyzed. Statistical Analysis: Chi‑square test was used to compare incidence of study variables. Independent Student’s t‑test was used for continuous variables. Demographic data were compared using ANOVA. P