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ABSTRACT

Aim: Postoperative nausea and vomiting (PONV) is a common complication after tonsillectomy. Midazolam is known to decrease postsurgical vomiting. In this study, we investigate the effect of intramuscular Midazolam on postoperative nausea vomiting in children undergoing adenoidectomy or adenotonsillectomy.
Material and Method: In a randomized double-blind study, we evaluated 66 healthy children, aged 5–12 years, who underwent adenoidectomy with or without tonsillectomy. Afterwards, anesthesia was induced by inhalation of sevoflurane, rocuronium bromide 0.6 mg kg^–1, and fentanyl 1 µg kg^–1, and anesthesia was maintained by sevoflurane for all patients. Patients were administered subcutaneous morphine 0.1 mg kg^–1 for postoperative analgesia. Patient’s in-Group II were administered intramuscular midazolam 0.1 mg kg^–1. The incidence of nausea/vomiting and antiemetic requirement 0-4 h and 4-24 h post surgery was recorded. Data for postoperative vomiting were grouped into the following time periods: 0–4 and 4–24 h. Data were analyzed using a Student’s t-test and chi-squared analysis.
Results: No statistically significant different was found between groups in 0-4, and 4-24 hours in terms of median VAS levels (p=0,883 and p=0,881). Although Group II had lower incidence of nausea both in 0-4 and 4-24 hours compared to Group I, there was no statistically significant difference between the groups (p=0,618 and p=0,28). There was no statistically significant difference between the groups in 0-4, and 4-24 hours in terms of median nausea VAS levels (p=0,597 and p=0,982). There was also no statistically significant difference between the groups in terms of rates of additional analgesic requirement in 24 hours, and median additional analgesic number (p=0,197 and p=0,865). Antiemetic requirement rates in 24 hours in Group II were lower at a statistically significant rate compared to Group I (p=0,027). Yet, there was no statistically significant difference between the groups in terms of median antiemetic number in 24 hours (p=0,070).
Conclusion: For children undergoing tonsillectomy, intraoperative midazolam treatment does not provide a prophylaxis against postoperative vomiting.

Keywords: Nausea Vomiting, Adenotonsillectomy, Midazolam

ÖZ

Amaç: Postoperatif bulantı kusma tonsillektomi sonrası en yaygın komplikasyondur. Biz de çalışmamızda adenotonsillektomi veya adenoidektomi olan çocuklarda intramuskuler midazolamın postoperatif bulantı kusmaya proflaktik etkisini araştırmayı amaçladık.
Gereç ve Yöntem: Çalışmaya 5-12 yaş arasında sağlıklı adenotonsillektomi veya sadece adenoidektomi olacak 66 çocuk randomize ve çift kör olarak çalışmaya dahil edildi. Sevofluran inhalasyonunu, 0.6 mgkg-1 rokuronyum bromid ve 1µg kg–1 fentanil lie anestezi indüksiyonunu takiben tüm olgularda idame sevofluran inhalasyon anestezisi ile sağlandı. Tüm hastalara subkutanöz morfin 0.1 mg kg–1 postoperatif analjezi amaçlı uygulandı. Grup II'de yer alan hastalara aynı standart anestezi protokolü yanında im midazolam 0.1 mg kg–1 entübasyon sonrası uygulandı.   Postoperatif   kusma verileri  0-4 ve  4-24. saat  periotlarında gruplandırıldı. Veriler Student t-testi ve Chi-squared testi ile analiz edildi.
Bulgular: Gruplar arasında 0-2 ve 2-24. saatlerde medyan VAS düzeyleri yönünden istatistiksel olarak anlamlı farklılık görülmedi (p=0,883 ve p=0,881). Gruplar arasında 24 saatte ek analjezik gereksinim oranları ve medyan ek analjezik sayısı yönünden de istatistiksel olarak anlamlı farklılık görülmedi (p=0,197 ve p=0,865). Grup I'e göre Grup II'de 24 saat antiemetik gereksinim oranı istatistiksel anlamlı olarak daha düşüktü (p=0,027).
Sonuç: Adenotonsillektomi  olacak  çocuklarda  intraoperative  sadece  midazolam  tedavisinin postoperatif kusmaya karşı korucu olamadığı düşüncesindeyiz.

Keywords: Bulantı-Kusma, Adenotonsillektomi, Midazolam