Nasreen Laiq, Shahid Khan, Muhammad Naeem Khan.
Prophylactic Dexamethasone as Antiemetic for Postoperative Nausea and Vomiting after Cardiac Surgery in High-Risk patients.
Ophthalmol Update Jan ;16(2):683-6.

Background: Postoperative nausea and vomiting (PONV) is a frequent complication after any surgical intervention, including cardiac surgery where incidence can reach 70%.Proposed explanations for these prevalent complications include particularly prolonged surgery with gut hypoperfusion, and endogenous catecholamine surgeClose attention should be paid to PONV after surgery in fragile cardiac patients in light of increased metabolic demands during emesis and the risks of aspiration. Prophylaxis is now a well-accepted approach for decreasing PONV after non-cardiac surgery. Drugs typically used for prophylaxis are independently associated with a 26% decrease in PONV, notably droperidol, ondansetron, and dexamethasone. Aims: To study the risk factors for PONV after cardiac surgery and the role of dexamethasone with or without for its prevention. Material and Methods: A randomized clinical trial was conducted on 100 patients, planned for cardiac surgery from July 2015 to July 2016 with patients in the cardiac ICU of Lady Reading Hospital Peshawar, Pakistan. 50 patients were enrolled into either of two groups in a randomized way. Group D received dexamethasone while Group N received normal saline. The primary outcome measure was the incidence of postoperative Nausea and vomiting in two groups after cardiac surgery. Approval for the study was taken from Institutional Research and Ethical board Lady Reading Hospital Peshawar. An informed consent was obtained from each patient enrolled in the study. Calculations were done using the SPSS, software pakage,version17,The student `t` test was performed to compare two data. Results were displayed in figures as mean ± SD. P values of 0.05 or < 0.05 were considered statistically significant. Results Patients demographics were almost similar between the two groups. There was no difference in the Cross-clamp time and Cardiopulmonary bypass times, intraoperative blood gases and haemodynamics were similar between the two groups. (P > 0.05).Postoperative Nausea and vomiting were significantly reduced in dexamethasone group versus control group (P < 0.05, significant). Length of stay in the intensive care unit (ICU) was also greatly reduced in Dexa group. Of the 100 patients in both groups, no serious complications were seen, while discharged from the ICU. Conclusion: Our study provides evidence that preoperative dexamethasone therapy is associated with a reduction in the incidence of PONV in high risk cardiac surgical patients without any side effect.

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