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AMBULATORY ANESTHESIOLOGY

Premedication with Mirtazapine Reduces Preoperative Anxiety and Postoperative Nausea and Vomiting

Chien-Chuan Chen, MD^*, Chia-Shiang Lin, MD^*, Yuan-Pi Ko, MD, Yu-Chun Hung, MD^*, Hsuan-Chih Lao, MD^*, and Yung-Wei Hsu, MD^*

From the *Department of Anesthesiology, Mackay Memorial Hospital, Taipei, Taiwan; Department of Anesthesiology, Hsinchu Mackay Memorial Hospital, Hsinchu, Taiwan; and Mackay Medicine, Nursing and Management College, Taipei, Taiwan.

Address correspondence and reprint requests to Yung-Wei Hsu, MD, Department of Anesthesiology, Mackay Memorial Hospital, 92, Section 2, Chungshan North Road, Taipei, Taiwan. Address e-mail to yungwei.hsu{at}msa.hinet.net.

Abstract

BACKGROUND: Mirtazapine is a new antidepressant that blocks 5-HT₂ and 5-HT₃ receptors. With this receptor profile, it is possible that mirtazapine could provide both anxiolysis and efficacy for postoperative nausea and vomiting (PONV). We therefore tested the hypothesis that premedication with mirtazapine can reduce preoperative anxiety and PONV.

METHODS: Eighty female patients with at least two PONV risk factors scheduled for gynecological surgery were enrolled. Dexamethasone 8 mg was given before induction of anesthesia and patients were randomly assigned to group M + D (mirtazapine plus dexamethasone) or group dexamethasone. An oral disintegrating mirtazapine 30 mg or placebo tablet was given 1 h before surgery. Preoperative anxiety level was assessed by a visual analog scale (VAS) before mirtazapine administration and 1 h thereafter. General anesthesia was induced with 1% propofol at the rate of 200 mL/h (until loss of consciousness) and was then maintained with sevoflurane in oxygen and air. An auditory evoked potentials index monitor was used to titrate sevoflurane. The incidence of PONV, the use of rescue antiemetic, complete response, postoperative Ramsay Sedation Scores, and VAS pain scores were assessed 1, 2, and 24 h after surgery and compared.

RESULTS: The VAS anxiety scale was lower in group M + D after mirtazapine administration. There were no differences in the induction dose of propofol, the concentrations of sevoflurane during anesthesia, and recovery times between the two groups. The incidence of complete response to PONV over 0–24 h was lower in group M + D (80% vs 50%, P < 0.01).

CONCLUSIONS: Premedication with mirtazapine 30 mg reduces the level of preoperative anxiety and the risk of PONV in moderate and high-risk female patients.

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999