To determine and compare the incidence of PONV with intra-operative use of Medical Air and Nitrous Oxide for General Anesthesia in patients undergoing Breast Surgery: A prospective randomized study
Journal Title: Journal of Medical Science And clinical Research - Year 2018, Vol 6, Issue 7
Abstract
Background: Post operative Nausea Vomiting (PONV) is one of the feared and incapacitating side effect of surgery that is associated with significant morbidity that leads to delayed recovery and prolonged hospital stay. Nitrous Oxide (N2O) widely used as an anaesthetic carrier gas. It has analgesic and sedative properties but it potentiates the incidence of PONV .Where as Medical Air (MA) is an inert, environment friendly and can safely be used as an alternate vehicle for anaesthesia. Methods: 60 female patients of ASA 1 &11 posted for Breast Surgery between March-September were randomly allocated in to two groups of 30 each. Group A received oxygen & Medical Air (Fio2 0.4),while Group B received oxygen & Nitrous oxide (Fio2 0.4) All the patients were induced with iv propofol (1- 2 mg/kg) & fentanyl (2 microgram/kg) and maintained with 40% oxygen with air/N2O & sevoflurane and vecuronium bromide(0.08mg/kg). All the patients were reversed with Neostigmine (0.05mg/kg) and glycopyrrolate (0.02mg/kg).As per recent PONV guideline all the patients received PONV prophylaxis as injection dexamethasone 4mg iv at the start of surgery and injection ondansetron 4mg iv at the end of surgery. At the end of surgery all of them received injection diclofenac in the dose of 1.5mg/kg iv which was repeated 8hrly in the post operative period. Paracetamol 15mg/kg was given iv on patient demand or when pain score goes above 4 on NRS, as rescue analgesia. PONV was recorded at 1st hr, 6hr and 12hr post operatively. Results: Incidence of PONV at 1st hr in MA group was only 3.3%,where as in Nitrous Oxide group it was 26.4 % with a p value of <0.023. At 6hrs, in MA group incidence was zero, where as in nitrous oxide group it was 20% with a p value of <0.023. The total incidence of PONV within 12 hrs was 1 patient in MA group where as 14 patients in N20 Group with a p value <0.0002. Total dose of paracetamol required in both the groups were comparable. Conclusion: MA group has significantly less incidence of PONV than Nitrous oxide group
Authors and Affiliations
Dr Arata Kumar Swain
Keywords
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