Purpose: Following laparoscopic surgeries, patients often experience discomfort and dissatisfaction due to postoperative nausea and vomiting (PONV), despite using a multimodal pharmacological approach. The study compared the effects of triple drug prophylaxis with aprepitant-dexamethasone-ondansetron versus dual drug prophylaxis with dexamethasoneondansetron in high-risk patients undergoing laparoscopic surgeries. Methods: This randomized controlled trial enrolled 201 female nonsmokers who used opioids postoperatively and underwent elective laparoscopic surgery. Patients were allocated into two groups: dual prophylactic antiemetics and placebo (control group), and triple prophylactic antiemetics with preoperative administration of aprepitant 80 mg (group A). Group A received oral aprepitant 80 mg 2 hours before the surgery, and the control group received a placebo.Patients were assessed at two time points: 2 hours after surgery, either in the postanesthesia care unit or in the ward, and 24 hours after surgery in the ward. Results: Patients in group A reported a PONV incidence of 10% as compared to 22.7% in the control group (relative risk,0.43; 95% confidence interval [CI], 0.22–0.89; adjusted p = 0.01) at 2 hours in the postoperative period. At 24 hours postoperatively, patients in group A experienced significantly lower incidence of PONV (10%) compared to the control group (29.7%; relative risk, 0.33; 95% CI, 0.17–0.64; p < 0.001). Also, the need for rescue antiemetics was reported to be lower in patients in group A. No adverse effects were reported with any of the drugs used. Conclusion The study suggests that prophylaxis with a triple antiemetic regimen consisting of aprepitant-dexamethasone-ondansetron results in a lower incidence of PONV compared with a two-drug regimen using dexamethasone-ondansetron in high-risk patients with three or more risk factors.

Background: Older patients are particularly vulnerable to age-related respiratory changes. This prospective randomized controlled trial studied the effects of high and low fractions of inspired oxygen (FiO2) with the recruitment maneuver (RM) during extubation on lung atelectasis postoperatively in older patients undergoing major abdominal surgery. Methods: We randomized a total of 126 patients aged >60 years who underwent both elective and emergency major abdominal surgeries and met the inclusion criteria into three groups (H, HR, and LR) using computer-generated block randomization. Group H received high FiO2 (1), Group HR received high FiO2 (1) with RM followed by a positive end-expiratory pressure of 5 cm H2O, and Group LR received low FiO2 (0.4) with RM followed by a positive end-expiratory pressure of 5 cm H2O 10 minutes before extubation. Oxygenation and atelectasis were measured using the arterial partial pressure of oxygen (PaO2)/FiO2 ratios and lung ultrasound score. Postoperative pulmonary complications were recorded up to 24 hours postoperatively. Results: The mean PaO2/FiO2 at 30 minutes post-extubation was significantly higher in Groups LR and HR compared to that in Group H (390.71±29.55, 381.97±24.97, and 355.37±31.70; p<0.001). In the immediate postoperative period, the median lung ultrasound score was higher in Group H than that in Groups LR and HR (6 [5–7], 3 [3–5], and 3.5 [2.25–4.75]; p<0.001). The incidence of oxygen desaturation and oxygen requirements was higher in Group H during the postoperative period. Conclusion The RM before extubation is beneficial in reducing atelectasis and postoperative pulmonary complications, irrespective of the FiO2 concentration used in older adults undergoing major abdominal surgeries. (Trail registration number: Reference No. CTRI/2022/04/042115; date of CTRI registration 25/02/2022; and date of enrolment of the first research participant 05/05/2022)