Antiemetic Efficacy of Dexamethasone Combined with Midazolam after Middle Ear Surgery

OBJECTIVES: To evaluate the antiemetic efficacy of dexamethasone combined with midazolam after middle ear surgery.

STUDY DESIGN: A prospective, randomized, double-blind, placebo-controlled study.

SETTING: University hospital.

SUBJECTS AND METHODS: The study population consisted of 120 American Society of Anesthesiologists physical status I or II, adult female patients undergoing middle ear surgery under general anesthesia. Patients were randomized into three groups of 40 each who received a dexamethasone dose of 10 mg/kg (group D), a combination of dexamethasone 10 mg and midazolam 0.075 mg/kg (group DM), and normal saline (group C) immediately after the induction of anesthesia. The incidence of nausea and vomiting, usage of rescue antiemetics, pain intensity, and side effects, such as headache and dizziness, were assessed during the first 24 hours after surgery.

RESULTS: The overall incidence of nausea and vomiting was significantly lower in group D (35%, P < 0.05) and group DM (25%, P < 0.05) compared with that in group C (65%). The incidences of vomiting and usage of rescue antiemetic drugs in group DM were lower than those in group D (P < 0.05). There were no significant differences among groups in pain intensity and side effects, such as headache and dizziness.

CONCLUSIONS: The combination of dexamethasone and midazolam was better than dexamethasone alone in reducing the incidence of vomiting and the rescue antiemetic requirements in women patients undergoing middle ear surgery. However, this combination treatment did not significantly decrease the overall incidence of nausea and vomiting compared with the use of dexamethasone alone.