The Addition of Midazolam Reduces the Incidence of Early Postoperative Nausea and Vomiting in Short Time Gynecological Procedures

Abstract

Background: If untreated, one third of patients who undergo surgery develop postoperative nausea and/or vomiting (PONV). The prevention of postoperative nausea and vomiting can improve satisfaction among vulnerable patients. We hypothesized that preoperative anxiety may increase the incidence of PONV. The objective was to assess whether administration of a benzodiazepine prior to surgery would reduce the incidence of PONV. Methods: 130 women (ASA I and II) scheduled to undergo dilatation and curettage comprised the study group. The women were allocated randomly to two study groups according to the type of anesthesia administered (with and without midazolam). Results: Sixty-eight women received midazolam and 62 did not. Patients treated with midazolam were feeling more comfortable (“friendliness”, p = 0.005 and “elation”, p = 0.01) and had less postoperative fatigue (p = 0.04) than non-midazolam-treated group. Patients treated with midazolam had significantly fewer emetic episodes during the first 4 hours after surgery than those without midazolam (0.1 ± 0.2 vs 0.3 ± 0.6, respectively, p = 0.003). Conclusions: Midazolam reduces the incidence of PONV and improves patient’s comfort. We suggest that midazolam has to be routinely included in the anesthesia protocol for short-term gynecological procedures (dilatation and curettage).

Share and Cite:

Rozentsveig, V. , Brotfain, E. , Klein, M. , Koyfman, L. , Boyko, M. and Zlotnik, A. (2015) The Addition of Midazolam Reduces the Incidence of Early Postoperative Nausea and Vomiting in Short Time Gynecological Procedures. Open Journal of Anesthesiology, 5, 13-19. doi: 10.4236/ojanes.2015.51003.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] Hill, R.P., Lubarsky, D.A., Phillips-Bute, B., Fortney, J.T., Creed, M.R., Glass, P.S., et al. (2000) Cost-Effectiveness of Prophylactic Antiemetic Therapy with Ondansetron, Droperidol, or Placebo. Anesthesiology, 92, 958-967.
http://dx.doi.org/10.1097/00000542-200004000-00012
[2] Apfel, C.C., Korttila, K., Abdalla, M., Kerger, H., Turan, A., Vedder, I., et al. (2004) A Factorial Trial of Six Interventions for the Prevention of Postoperative Nausea and Vomiting. New England Journal of Medicine, 350, 2441-2451.
http://dx.doi.org/10.1056/NEJMoa032196
[3] Koivuranta, M., Laara, E., Snare, L. and Alahuhta, S. (1997) A Survey of Postoperative Nausea and Vomiting. Anaesthesia, 52, 443-449.
http://dx.doi.org/10.1111/j.1365-2044.1997.117-az0113.x
[4] Watcha, M.F. (2000) The Cost-Effective Management of Postoperative Nausea and Vomiting. Anesthesiology, 92, 931-933.
http://dx.doi.org/10.1097/00000542-200004000-00007
[5] Stadler, M., Bardiau, F., Seidel, L., Albert, A. and Boogaerts, J.G. (2003) Difference in Risk Factors for Postoperative Nausea and Vomiting. Anesthesiology, 98, 46-52.
http://dx.doi.org/10.1097/00000542-200301000-00011
[6] Gan, T.J., Meyer, T.A., Apfel, C.C., et al. (2007) Society for Ambulatory Anesthesia Guidelines for the Management of Postoperative Nausea and Vomiting. Anesthesia Analgesia, 105, 1615-1628.
http://dx.doi.org/10.1213/01.ane.0000295230.55439.f4
[7] Watcha, M.F. and White, P.F. (1992) Postoperative Nausea and Vomiting. It’s Etiology, Treatment and Prevention. Anesthesiology, 77, 162-184.
http://dx.doi.org/10.1097/00000542-199207000-00023
[8] Lichtor, J.L., Johanson, C.E., Mhoon, D., Faure, E.A., Hassan, S.Z. and Roizen, M.F. (1987) Preoperative Anxiety: Does Anxiety Level the Afternoon before Surgery Predict Anxiety Level Just before Surgery? Anesthesiology, 67, 595-599.
http://dx.doi.org/10.1097/00000542-198710000-00031
[9] Carroll, N.V., Miederhoff, P., Cox, F.M. and Hirsch, J.D. (1995) Postoperative Nausea and Vomiting after Discharge from Outpatient Surgery Centers. Anesthesia Analgesia, 80, 903-909.
[10] Rabey, P.G. and Smith, G. (1992) Anaesthetic Factors Contributing to Postoperative Nausea and Vomiting. British Journal of Anaesthesia, 69, 40S-45S.
http://dx.doi.org/10.1093/bja/69.supplement_1.40S
[11] Wetchler, B.V. (1991) Outpatient Anesthesia. What Are the Problems in the Recovery Room? Canadian Journal of Anesthesia, 38, 890-894.
http://dx.doi.org/10.1007/BF03036968
[12] Eberhart, L.H., Hogel, J., Seeling, W., Staack, A.M., Geldner, G. and Georgieff, M. (2000) Evaluation of Three Risk Scores to Predict Postoperative Nausea and Vomiting. Acta Anaesthesiologica Scandinavica, 44, 480-488.
http://dx.doi.org/10.1034/j.1399-6576.2000.440422.x
[13] Kenny, G.N. (1994) Risk Factors for Postoperative Nausea and Vomiting. Anaesthesia, 49, 6-10.
http://dx.doi.org/10.1111/j.1365-2044.1994.tb03576.x
[14] Paxton, L.D., McKay, A.C. and Mirakhur, R.K. (1995) Prevention of Nausea and Vomiting after Day Case Gynaecological Laparoscopy. A Comparison of Ondansetron, Droperidol, Metoclopramide and Placebo. Anaesthesia, 50, 403-406.
http://dx.doi.org/10.1111/j.1365-2044.1995.tb05993.x
[15] Apfel, C.C., Greim, C.A., Haubitz, I., Grundt, D., Goepfert, C., Sefrin, P., et al. (1998) The Discriminating Power of a Risk Score for Postoperative Vomiting in Adults Undergoing Various Types of Surgery. Acta Anaesthesiologica Scandinavica, 42, 502-509.
http://dx.doi.org/10.1111/j.1399-6576.1998.tb05158.x
[16] Toner, C.C., Broomhead, C.J., Littlejohn, I.H., Samra, G.S., Powney, J.G., Palazzo, M.G., et al. (1996) Prediction of Postoperative Nausea and Vomiting Using a Logistic Regression Model. British Journal of Anaesthesia, 76, 347-351.
http://dx.doi.org/10.1093/bja/76.3.347
[17] Park, J.W., Jun, J.W., Lim, Y.H., Lee, S.S., Yoo, B.H., Kim, K.-M., Yon, J.H. and Hong, K.H. (2012) The Comparative Study to Evaluate the Effect of Palonosetron Monotherapy versus Palonosetron with Dexamethasone Combination Therapy for Prevention of Postoperative Nausea and Vomiting. Korean Journal of Anesthesiology, 63, 334-339.
[18] D’souza, N., Swami, M. and Bhagwat, S. (2011) Comparative Study of Dexamethasone and Ondansetron for Prophylaxis of Postoperative Nausea and Vomiting in Laparoscopic Gynecologic Surgery. International Journal of Gynecology and Obstetrics, 113, 124-127.
http://dx.doi.org/10.1016/j.ijgo.2010.11.022
[19] Korttila, K., Ostman, P., Faure, E., Apfelbaum, J.L., Prunskis, J., Ekdawi, M., et al. (1990) Randomized Comparison of Recovery after Propofol-Nitrous Oxide versus Thiopentone-Isoflurane-Nitrous Oxide Anaesthesia in Patients Undergoing Ambulatory Surgery. Acta Anaesthesiologica Scandinavica, 34, 400-403.
http://dx.doi.org/10.1111/j.1399-6576.1990.tb03111.x
[20] Boysen, K., Sanchez, R., Krintel, J.J., Hansen, M., Haar, P.M. and Dyrberg, V. (1989) Induction and Recovery Characteristics of Propofol, Thiopental and Etomidate. Acta Anaesthesiologica Scandinavica, 33, 689-692.
http://dx.doi.org/10.1111/j.1399-6576.1989.tb02993.x
[21] Edelist, G. (1987) A Comparison of Propofol and Thiopentone as Induction Agents in Outpatient Surgery. Canadian Journal of Anesthesia, 34, 110-116.
http://dx.doi.org/10.1007/BF03015326
[22] Doze, V.A., Shafer, A. and White, P.F. (1988) Propofol-Nitrous Oxide versus Thiopental-Isoflurane-Nitrous Oxide for General Anesthesia. Anesthesiology, 69, 63-71.
http://dx.doi.org/10.1097/00000542-198807000-00010
[23] Marcovic, M., Bandyopadhyay, M., Manderson, L., Allotey, P., Murray, S. and Vu, T. (2004) Day Surgery in Australia. Quantitative Research Report. Journal of Sociology, 40, 74-84.
http://dx.doi.org/10.1177/1440783304040454
[24] Aylin, P., Williams, S., Jarman, B. and Bottle, A. (2005) Trends in Day Surgery Rates. British Medical Journal, 331, 803.
http://dx.doi.org/10.1136/bmj.331.7520.803
[25] Green, G. and Jonsson, L. (1992) Nausea: The Most Important Factor Determining Length of Stay after Ambulatory Anaesthesia. Acta Anaesthesiologica Scandinavica, 36, 182-186.
[26] Andersson, L., Sundstrom-Poromaa, I., Wulff, M., Astrom, M. and Bixo, M. (2004) Implications of Antenatal Depression and Anxiety for Obstetric Outcome. Obstetrics Gynecology, 104, 467-476.
http://dx.doi.org/10.1097/01.AOG.0000135277.04565.e9
[27] Wang, S.M. and Kain, Z.N. (2000) Preoperative Anxiety and Postoperative Nausea and Vomiting in Children: Is There an Association? Anesthesia Analgesia, 90, 571-575.
http://dx.doi.org/10.1097/00000539-200003000-00014
[28] Di Florio, T. (1992) The Use of Midazolam for Persistent Postoperative Nausea and Vomiting. Anaesthesia and Intensive Care, 20, 383-386.
[29] Bauer, K.P., Dom, P.M., Ramirez, A.M. and O’Flaherty, J.E. (2004) Preoperative Intravenous Midazolam: Benefits beyond Anxiolysis. Journal of Clinical Anesthesia, 16, 177-183.
http://dx.doi.org/10.1016/j.jclinane.2003.07.003
[30] Chung, F., Un, V. and Su, J. (1996) Postoperative Symptoms 24 Hours after Ambulatory Anaesthesia. Canadian Journal of Anesthesia, 43, 1121-1127.
http://dx.doi.org/10.1007/BF03011838

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.