Ondansetron combined with aprepitant versus dexamethasone combined with metoclopramide; which is more efficient to reduce nausea and vomiting after etomidate induction in major vascular surgeries

Postoperative nausea and vomiting (PONV) is an outcome that is very important to patients; patients often rate PONV worse than postoperative pain. Etomidate is the choice drug that is used to induce anesthesia in high risk and major vascular surgeries. Major side effects of etomidate is PONV and suppression of hypophysis pituitary adrenal axis. Current study was designed to evaluate the effect of the ondansetron and aprepitant vs. dexamethasone and with metoclopramide on PONV in patients underwent major vascular surgeries.

120 patients enrolled in this study and randomly divided into 2 groups. Group 1 (DM) received dexamethasone 8 mg and 10 mg metoclopramide and group 2 (OA) recieved aprepitant 80 mg and ondansetron 4 mg. the rate of PONV was compared between groups.

There were 26 and 12 cases with nausea in the (DM) and (OA) groups, respectively, over the first 3 hours postoperatively. Also, 4 patients in the (DM) group experienced vomiting, while no patient in the (OA) group seen with vomiting. There were statistically meaningful differences between two groups in the means of nausea and vomiting (p=0.031 & 0.043).

use of Ondansetron-Aprepitant combination is an efficient antiemetic protocol to reduce the rate of PONV in patients receiving etomidate for major surgeries. Potentially, it is more potent in prevention of vomiting than nausea. ondansetron and aprepitant are more appropriate in the prevention of the PONV comparing with dexamethasone and metoclopramid