Mirtazapine Versus Dexamethasone in Preventing Postoperative Nausea and Vomiting
Mirtazapine Versus Dexamethasone in Preventing Postoperative Nausea and Vomiting
Mirtazapine is a noradrenergic and specific serotonergic antidepressant. Its antagonist at
 the 5HT3 receptor may help to prevent nausea and vomiting. The use of mirtazapine in the
 management of nausea and vomiting has been reported in the literature, both for treatment and
 premedication.

 Dexamethasone, possesses analgesic, anti-inflammatory, immune-modulating, and antiemetic
 effects. Dexamethasone was reported to be effective in preventing nausea and vomiting in
 patients receiving cancer chemotherapy. It has also been shown to be effective in reducing
 nausea and vomiting after open and laparoscopic surgical procedures.

 In this randomized controlled trial, we will compare the effectiveness of both drugs in
 preventing PONV in laparoscopic cholecystectomy surgery.
this double-blinded randomized study will be conducted at Ain-Shams university hospitals.
 Patients are aged 21-60 years and body weight 60-100 Kg of the American Society of
 Anaesthesiologists (ASA) physical status I or II scheduled for laparoscopic cholecystectomy
 under general anesthesia will be enrolled in this study., patients will be randomly divided
 into 2 equal groups; The M(Mirtazapine) group:(n=45) each patient will receive an oral
 disintegrating tablet (ODT) of mirtazapine 30 mg with sips of water and 100 ml 0.9% sodium
 chloride (normal saline [NS]) (IVI) over 15 min as a placebo 1 h preoperatively.

 The D (Dexamethasone) group: (n=45) each patient will receive a placebo tablet identical to
 Mirta tablet orally with sips of water and Dex 8 mg ampoule diluted in 100 ml 0.9% NS IVI
 over 15 min, 1 h preoperatively.

 standard monitoring in the form of (ECG, pulse oximeter, NIBP, peripheral temperature
 monitoring) will be attached to all patients and capnography will be connected after
 intubation. baseline measures will be recorded, and subsequent values will be recorded every
 15 min. Patients will be observed for 24 hours postoperative. And the following will be
 recorded; Time to awakening (time from the end of anesthesia until the patients opened their
 eyes on command) and Time to the first analgesia. Patients´ vital data (BP, HR, RR, O2
 saturation) will be monitored every 15 minutes for the first postoperative hour, then every 4
 hours. Postoperative pain will be assessed every 4 hours with a 10-cm visual analog scale VAS
 (0=no pain to 10=most severe pain) score. The incidence of occurrence of postoperative Nausea
 and vomiting will be evaluated every 4 hours on a two-point verbal scale (0, none; 1, nausea
 or vomiting). The severity of nausea and vomiting will be assessed using a verbal numerical
 rating scale from 0 = no nausea/ vomiting and 10 = nausea/ vomiting as bad as it could be.The
 complete response is defined as no nausea, no vomiting, and no antiemetic medication during a
 24-h postoperative period
Inclusion Criteria:

 -  ASA physical status I or II

 -  body weight 60-100 Kg

 -  scheduled for laparoscopic cholecystectomy under general anaesthesia

 Exclusion Criteria:

 -  Patient's refusal to participate in the study,

 -  Obesity with body mass index (BMI) >35 kg/m2,

 -  Physical status: ASA III or above,

 -  Patients with a history of PONV, motion sickness, or major systemic diseases

 -  Patients who received an antiemetic drug within 48 h before surgery,

 -  Patients facing liver or kidney problems with a high level of BUN or serum creatinine,

 -  A history of allergy to the study drugs.

 -  Pregnant, lactating, or menstruating patients