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Canadian Journal of Anesthesia, Vol 15, 80-91, Copyright © 1968 by Canadian Anesthesiologists' Society

Double-Blind Evaluation of Metoclopramide (Mk 745, Sinemet®), Trimethobenzamide (Tigan®), and a Placebo as Postanaesthetic Anti-Emetics following Methoxyflurane Anaesthesia

ALLEN B. DOBKIN M.D., WILLIAM EVERS M.D., and JACOB S. ISRAEL M.D.

A double-blind comparison of a placebo, metoclopramide, and trimethobenzamide was carried out on 284 adult patients who were scheduled for elective major upper abdominal surgery under methoxyflurane-nitrous-oxide anaesthesia. The drugs were given intravenously, according to a random assignment number code, approximately 30 minutes before the end of an operation. Vital signs and other signs and symptoms were observed by a trained nurse and were recorded for six hours after the test drug was administered. Each patient's record was reviewed 24 hours after the operation to obtain follow-up data.

Metoclopramide (20 mg.) and trimethobenzamide (300 mg.) were not better than the placebo with respect to the incidence of nausea and vomiting during the first twenty-four hours after an operation in the patients that did not have nasogastric suction. The patients who had nasogastric suction postoperatively had at least 50 per cent lower incidence of nausea and vomiting. This effect was particularly prominent in the patients who received metoclopramide.

In approximately one-third of the patients who developed nausea and vomiting, these symptoms were associated with the prior administration of a narcotic analgesic within four hours whether or not they received a potentially active anti-emetic drug.

Neither metoclopramide nor trimethobenzamide appeared to have any undesirable effect on the respiration, circulation, or rate of recovery from methoxyflurane anaesthesia.

On the basis of this study, it appears that neither of the anti-emetic compounds is effective in reducing the incidence of nausea and vomiting associated with the administration of methoxyflurane-nitrous-oxide anaesthesia for major upper abdominal operations. The administration of narcotic analgesic drugs appeared to be an initiating factor in about one-third of the patients who developed nausea and vomiting postoperatively. The only treatment which appeared to reduce the incidence of this complication effectively was the application of nasogastric suction.

Note:

From the Department of Anesthesiology, State University Hospital, State University of New York, Upstate Medical Center, Syracuse, New York.






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Copyright © 1968 by the Canadian Anesthesiologists' Society.