The Use of Midazolam for Persistent Postoperative Nausea and Vomiting

The management of postoperative nausea and vomiting in some patients remains a difficult problem.Many precautions can be taken perioperatively to decrease the likelihood of vomiting but once it occurs our pharmacological intervention relies mainly on antidopaminergic drugs.The successful use of midazolam in conjunction with antidopaminergic drugs to control postoperative vomiting is reported here. Case JA 38-year-old, 85 kg woman was scheduled as a day-case for laparoscopy for the investigation of infertility.Her previous general anaesthetics for tubal ligation and tubal reanastomosis were both complicated by postoperative nausea and vomiting.She was a smoker of 20 cigarettes per day.Her preoperative assessment was otherwise unremarkable.Temazepam 20 mg and metoclopramide 10 mg were given orally one hour before operation.Droperidol 2 mg and fentanyl 100 mcg were given intravenously immediately prior to induction of anaesthesia with propofol 100 mg.She was easy to ventilate by mask and intubation was facilitated by vecuronium 6 mg.General anaesthesia was maintained with nitrous oxide:oxygen (70:30) and enflurane 0.6%.During the thirty-minute anaesthetic she received Hartmann's solution 1000 ml and remained haemodynamically stable.An indomethacin suppository 100 mg was inserted at the end of the operation.She was reversed with neostigmine 2.5 mg and atropine 1.2 mg, extubated on her side and taken to the recovery room.In the recovery room she vomited once and complained of abdominal pain, for which she received pethidine 25 mg intravenously.Over the next thirty minutes she experienced no further pain or vomiting and remained haemodynamically stable and so was returned to the ward.