Nikhi^l Mudgalkar¹, K.Ravinder Reddy², Lanka Siva rama prasad³

¹Associate Professor,Department of Anaesthesiology, ² Professor,Department of General Medicine and Consultant Cardiologist ,³Associate Professor, Department of General Surgery and Consultant Cardiac Surgeon,Prathima Institute of Medical Sciences,Karimnagar,Telangana,India.

Address for correspondence: Dr. Nikhil Mudgalkar, Associate Professor,Department of Anaesthesiology Prathima Institute of Medical Sciences,Karimnagar,Telanagana,India.

Email: drniks200@yahoo.com

Introduction: Postoperative nausea and vomiting (PONV) is distressing complication of anesthesia and surgery. There are very few studies of prevalence of PONV in cardiac surgical population, and in Indian scenario.

Objectives: To study incidence of postoperative nausea and vomiting, in Indian scenario and association of PONV with various factors and efficacy of Palonosetron verses Ondensetron in this prospective randomized control trial.

Material and Methods:All patients undergoing open cardiac surgical procedures including off pump, on pump coronary artery bypass grafting, aortic valve replacement, and mitral valve replacement and combined procedures. Patients were aimed at facilitating tracheal extubation within 8–10 h after surgery and discharge from the ICU on postoperative day 3. Patients who had received anti‐emetic medication before surgery were excluded. Preoperative and ICU‐related data were collected. Preoperative variables included age, sex, and obesity, history of diabetes, renal insufficiency and previous PONV and/or motion sickness. ICU‐related data included numbered of episodes of PONV, need for rescue medication, and QTc interval. Patients who developed PONV were randomized by computer generated random number table to receive injection Palonosetron 0.075mg and injection Ondensetron 4 mg intravenous.

Results: A total of 169 patients were included in the study. Nearly 49% of the patients were above 60 years of age. 34% were females and nearly 50% were diabetic. Previous history of PONV was present in 22% of the cases. Majority of cases included coronary artery bypass grafting and mitral valve replacement which were 47 and 31 % respectively. PONV was documented in 30.76 % of cases. History of PONV, diabetic status, female sex and transesophageal echo use was found to be significantly associated with PONV with p values of 0.0422, 0.0513, 0.002, and 0.0038 respectively. Out of total 52 cases which developed PONV, 30 cases were randomized to receive Palonosetron while 22 received Ondensetron. Complete recovery was observed in 29 cases of Palonosetron while 19 cases of Ondensetron. This difference did not culminate into statistically significant levels with p value of 0.3499 indicating both drugs were similar in efficacy for PONV

Conclusion: Data on PONV in cardiac surgical patients is limited in Indian scenario, the incidence is high and is around 30%. In addition to classic risk factors, transesophageal echo use is another risk factor for PONV. Newer 5HT3 antagonist Palonosetron is equally effecitive for PONV treatment as Ondensetron.

Keywords :Palonosetron, Ondensetron, Post operative nausea