Prevention of postoperative nausea and vomiting with a small dose of propofol combined with dexamethasone 4 mg or dexamethasone 8 mg in patients undergoing middle ear surgery: a prospective, randomized, double-blind study.

OBJECTIVE Postoperative nausea and vomiting (PONV) is a common complication after middle ear surgery. We have aimed to compare the administration of a subhypnotic dose of propofol with dexamethasone 4 mg or 8 mg and placebo in prevention of postoperative nausea and vomiting (PONV) after middle ear surgery. METHOD This clinical research was performed at Yüksek Ihtisas Hospital Kirikkale. The study included 105 adult patients scheduled for a middle ear operation. The patients were randomly assigned into three groups. The patients in Group I received propofol in a dose of 0.5 mg x kg(-1) plus 4 mg of dexamethasone while Group II was administered with propofol in a dose of 0.5 mg x kg(-1) plus 8 mg of dexamethasone, and Group III was given 0.9% saline solution. Within the framework of the study we evaluated the number of patients suffering from nausea and vomiting at 0-4, 4-12, and 12-24 hours postoperatively, and the necessity to use additional antiemetics. RESULTS The comparison of data showed that at up to four hours, the incidence of vomiting was 28.6% in Group 1, 22.9% in Group II, and 65.7% in Group III. The incidence rates in Group I and Group II were significantly lower than that in Group III (p < 0.05), while the rate of antiemetic drug usage was higher in Group III than in Group I and Group II (p < 0.05). The Nausea Vomiting Scale scores were also significantly higher in Group III than in Group I and Group II (p < 0.05). There were no significant differences between the values at 4-12 and 12-24 hours. CONCLUSION The administration of a subhypnotic dose of propofol plus 4 mg of dexamethasone at the end of surgery was found to be at least as effective as propofol plus 8 mg of dexamethasone in preventing the PONV in the early postoperative period in adult patients undergoing middle ear surgery (Tab. 4, Ref. 34).