6.

BRIEF RESUME OF THE INTENDED WORK:

6.1 NEED FOR THE STUDY:
Anaesthesia has bec!e "e!a"#ab$% sa&e' an( )hi$e (eath an( *e"!anent (a!a+e ha,e bec!e
"a"e cc-""ences' the" se.-e$ae & anesthesia a"e +ainin+ !"e i!*"tance. /st*e"ati,e na-sea
an( ,!itin+ 0/ON12 is ne & the !st c!!n an( (ist"essin+ c!*$icatins a&te"
anaesthesia an( s-"+e"%' an( !a% $ea( t se"i-s *st*e"ati,e c!*$icatins. /ON1 sti$$ is the
!st t"-b$es!e a(,e"se e,ent enc-nte"e( in the "ec,e"% "!' (es*ite a(,ances in
*"e,entin an( t"eat!ent. F-"the"!"e' the n+in+ t"en( t)a"( a!b-$at"% *"ce(-"es has
inc"ease( the &c-s n /ON1 as its cc-""ence !a% (e$a% (ischa"+e " ca-se -nantici*ate(
hs*ita$ a(!issin. The ,e"a$$ inci(ence & /ON1 has been "e*"te( t be bet)een 345 an(
645' b-t can inc"ease -* t 745 in hi+h8"is# *atients. /atients -n(e"+in+ +%naec$+ica$
s-"+e"% ha,e been assciate( )ith hi+h "is# &" (e,e$*in+ /ON1
1
The eti$+% & /ON1 a&te"
+%nec$+ic s-"+ica$ *"ce(-"es *e"&"!e( is nt #n)n' b-t it is *"bab$% !-$ti&act"ia$ . A
n-!be" & &act"s' inc$-(in+ a+e' +en(e"' besit%' a hist"% & !tin sic#ness an(9" *"e,i-s
/ON1' !enst"-atin' s-"+ica$ *"ce(-"e' anesthetic techni.-e an( *st*e"ati,e *ain a"e
cnsi(e"e( t a&&ect the inci(ence & /ON1

.
Sciet% &" A!b-$at"% Anesthesia :-i(e$ines &" the Mana+e!ent & /st*e"ati,e Na-sea an(
1!itin+' 344; "ec!!en(s that a(-$ts at !(e"ate "is# &" /ON1 sh-$( "ecei,e c!binatin
the"a*% )ith ne " !"e *"*h%$actic ("-+s &"! (i&&e"ent c$asses as c!binatin the"a*% has
s-*e"i" e&&icac% c!*a"e( )ith !nthe"a*% &" /ON1 *"*h%$a<is
2
. D"-+s )ith (i&&e"ent
!echanis!s & actin sh-$( be -se( in c!binatin t *ti!i=e e&&icac%
3
. The "ec!!en(e(
&i"st8 an( secn(8$ine *ha"!ac$+ic anti e!etics &" /ON1 *"*h%$a<is in a(-$ts inc$-(e the >8
h%("<%t"%*ta!ine 0>8HT62 "ece*t" anta+nists 0n(anset"n' ($aset"n' +"aniset"n'
"a!set"n an( t"*iset"n2' ste"i( 0(e<a!ethasne2' *henthia=ines 0*"!etha=ine an(
*"ch$"*e"a=ine2' *hen%$eth%$a!ine 0e*he("ine2' b-t%"*hennes 0("*e"i($' ha$*e"i($2'
antihista!ine 0(i!enh%("inate2' an( antich$ine"+ic 0t"ans(e"!a$ sc*$a!ine2.
F" /ON1 *"e,entin' se$ecti,e se"tnin >8h%("<%t"%*ta!ine t%*e 6 0>8HT62 "ece*t"
anta+nists a"e cnsi(e"e( ne & the &i"st8$ine the"a*% beca-se & thei" e&&icac% an( &e) si(e8
e&&ects c!*a"e( )ith the" anti e!etics. The !st c!!n$% -se( >8HT6 "ece*t" anta+nist
has been n(anset"n' an( its antie!etic e&&icac% has been )e$$ estab$ishe( in che!the"a*%8
in(-ce( e!esis an( in *"e,entin an( t"eat!ent & /ON1
4, 5
.
The c"ticste"i(' (e<a!ethasne' e&&ecti,e$% *"e,ents na-sea an( ,!itin+
6
. It is
"ec!!en(e( at a *"*h%$actic (se & ?@> !+ I1 &" *atients at inc"ease( "is# &" /ON1. The
>8HT6 anta+nists can be e&&ecti,e$% c!bine( )ith (e<a!ethasne.
A!binatin & n(anset"n ?!+ an( (e<a!ethasne 7!+ has been &-n( t be e&&ecti,e
*"*h%$actic t"eat!ent &" *"e,entin & *st*e"ati,e na-sea an( ,!itin+ in (a% case
+%naec$+ica$ s-"+e"ies
6
.
Ra!set"n is a ne)$% (e,e$*e( >8HT6 "ece*t" anta+nist )ith a !"e *tent an( $n+e"
"ece*t" anta+ni=in+ e&&ect c!*a"e( )ith $(e" >8HT6 "ece*t"s anta+nists. In a((itin' the
e$i!inatin ha$&8$i&e & "a!set"n 0B h2 is $n+e" than that & n(anset"n 06.> h2. Beca-se &
these *ha"!ac$+ica$ *"*e"ties' "a!set"n is "e*"te($% !"e *tent )ith a $n+e" (-"atin &
actin than $(e" >8HT6 "ece*t" anta+nists c$inica$$%.
A c!binatin & "a!set"n an( (e<a!ethasne has been sh)n t be an e&&ecti,e t"eat!ent t
*"e,ent ac-te che!the"a*%8in(-ce( na-sea an( ,!itin+
7
. The e&&ecti,e (se & "a!set"n &"
*"e,entin+ /ON1 is sh)n t be 4.6!+
8
. A&te" !aC" +%naec$+ic s-"+e"% *"*h%$actic the"a*%
)ith "a!set"n is sh)n t be !"e e&&ecti,e than n(anset"n

(-"in+ the &i"st 3? h-"s
9
"
!"e e&&ecti,e than +"aniset"n &" $n+ te"! *"e,entin & /ON1
10
.
Hence the *"esent st-(% is -n(e"ta#en t e,a$-ate the e&&icac% & "a!set"n an( (e<a!ethasne
c!binatin an( c!*a"e it )ith e&&icac% & n(anset"n an( (e<a!ethasne in *"e,entin+
/ON1 a&te" +%naec$+ica$ s-"+e"% -n(e" s*ina$ anaesthesia.
6.2 REVIEW OF LITERATURE:
In a *"s*ecti,e' "an(!i=e(' (-b$e8b$in(e(' *$aceb8cnt"$$e( st-(% Olando L et al in
1996, assesse( the sa&et% an( e&&icac% & sin+$e int"a,en-s 0I12 (se & (e<a!ethasne 7!+'
n(anset"n ?!+' n(anset"n ?!+ )ith (e<a!ethasne 7!+ in the *"*h%$a<is & /ON1 in
&e!a$es -n(e"+in+ e$ecti,e !aC" +%naec$+ica$ s-"+e"%. The% bse",e( that the c!binatin
& n(anset"n )ith (e<a!ethasne )as !st e&&ecti,e in "e(-cin+ /ON1. The% in&e""e( that
this c!binatin' beca-se & the absence & si(e e&&ects an( se(atin c-$( be -se&-$ in (a% ca"e
s-"+ica$ *"ce(-"es
4
.
In a *"s*ecti,e "an(!i=e(' (-b$e8b$in(e( st-(% Fu!! " et al in 1999 c!*a"e( the
e&&icac% & +"aniset"n 3.>!+ D "a!set"n 4.6!+ I1 in *"e,entin+ /ON1' in !aC"
+%naec$+ic s-"+e"ies. The% cnc$-(e( that *"*h%$actic the"a*% )ith "a!set"n 4.6!+ )as
!"e e&&ecti,e than +"aniset"n 3.>!+ &" *"e,entin+ /ON1 3?8?7 h-"s a&te" anaesthesia
10
.
#$n%! I et al !n 2000 cn(-cte( a .-antitati,e s%ste!atic "e,ie) & 1B t"ia$s t (e&ine the
antie!etic e&&icac% an( sa&et% & (e<a!ethasne in the *"e,entin & /ON1. The t"ia$s inc$-(e(
(e<a!ethasne' >HT6 "ece*t" anta+nists an( c!binatin the"a*% &" /ON1. The% cnc$-(e(
that the best *"*h%$a<is & /ON1 is achie,e( b% c!binin+ (e<a!ethasne )ith the >HT6
"ece*t" anta+nists
6
.
In a *"s*ecti,e' "an(!i=e(' (-b$e8b$in(e(' *$aceb8cnt"$$e(' (se8"an+in+ st-(% &
"a!set"n &" the *"e,entin & na-sea an( ,!itin+ in )!en -n(e"+in+ +%nec$+ica$
s-"+e"%' Fu!! $& al in 2000 e,a$-ate( the e&&icac% & "a!set"n in (ses & 4.1>!+' 4.6!+'
4.6!+ in *"e,entin+ *st*e"ati,e na-sea an( ,!itin+ )ithin the &i"st ?7 h-"s a&te"
anaesthesia. The% cnc$-(e( that "a!set"n 4.6!+ is e&&ecti,e antie!etic &" *"e,entin+ /ON1
an( inc"ease in the (se t 4.6!+ *",i(e( n &-"the" bene&it
8
.
Wan' ((, $& al in 2000 st-(ie( the e&&ect & ti!in+ & (e<a!ethasne 14!+
a(!inist"atin in *"e,entin+ /ON1 n )!en -n(e"+in+ tta$ ab(!ina$ h%ste"ect!% -n(e"
+ene"a$ anaesthesia. De<a!ethasne 014!+2 )as a(!iniste"e( eithe" be&"e in(-ctin " at the
en( & anaesthesia in t) )e$$ !atche( +"-*s. The st-(% cnc$-(e( that the *"*h%$actic I.1.
a(!inist"atin & (e<a!ethasne i!!e(iate$% be&"e the in(-ctin' "athe" than at the en( &
anaesthesia' )as !"e e&&ecti,e in *"e,entin+ /ON1
11
.
T)o*a+ R, $& al in 2001 cn(-cte( a *"s*ecti,e "an(!i=e(' (-b$e b$in( c!*a"ati,e
st-(% & (e<a!ethasne 07!+2' n(anset"n 0?!+2 an( c!binatin & n(anset"n 0?!+2 *$-s
(e<a!ethasne 07!+2' as *"*h%$actic antie!etic the"a*% n *atients -n(e"+in+ (a% case
+%naec$+ica$ s-"+e"%. The inci(ence & /ON1 in the &i"st 6 h-"s )as $east in the +"-* )hich
"ecei,e( c!binatin & n(anset"n 0?!+2 *$-s (e<a!ethasne 07!+2 an( the"e )as n
si+ni&icant (i&&e"ence (-"in+ the 6813 an( 1383? h-"s *e"i(s
5
.
In a *"s*ecti,e' "an(!i=e(' (-b$e8b$in(e(' *$aceb8cnt"$$e(' (se8"an+in+ st-(%'
,!* $& al in 2009 c!*a"e( the e&&icac% & "a!set"n 4.6!+ &" *"e,entin & /ON1 )ith
that & n(anset"n 7!+ " *$aceb in hi+h "is# *atients -n(e"+in+ +%naec$+ica$ s-"+e"ies.
The% e,a$-ate( the inci(ence & /ON1' se,e"it% & na-sea an( -se & "esc-e antie!etic
"e.-i"e!ents (-"in+ the &i"st 3? h-"s a&te" s-"+e"%. The% cnc$-(e( "a!set"n 4.6!+ I1
+i,en be&"e the en( & s-"+e"% )as as e&&ecti,e as n(anset"n 7!+ I1 in *"e,entin+ /ON1
(-"in+ the &i"st 3? h-"s a&te" +%naec$+ica$ s-"+e"ies
9
.
-)!n'.L!an' #, Wu.-)ou /, Ru$0.,u$n #, 1)on'.1)$ L and T+u."! -)ao !n2010
cn(-cte( a "an(!i=e(' (-b$e8b$in(' *a"a$$e$' c!*a"ati,e st-(% t e,a$-ate the e&&icac% an(
sa&et% & "a!set"n *$-s (e<a!ethasne inCectin &" the *"e,entin & ac-te che!the"a*%8
in(-ce( na-sea an( ,!itin+ 0AIN12in cance" *atients che!the"a*% cntainin+ eithe" & the
&-" (-+s0cis*$atin'(<"-bicin'e*i"-bicin " <a$i*$atin2. The% cnc$-(e( that in c!*a"isn
)ith +"aniset"n' a c!binatin & "a!set"n 4.6!+ *$-s (e<a!ethasne 34!+ can be -se( as
an a$te"nati,e +i,en t *"e,ent ac-te AIN1
7
.
6.3 O2(E-TIVE OF T#E /TU3":
T e,a$-ate the e&&ecti,eness & c!binatin & "a!set"n 4.6!+ an( (e<a!ethasne
7!+ in *"e,entin & *st *e"ati,e na-sea an( ,!itin+' in *atients -n(e"+in+
+%naec$+ica$ s-"+e"ies -n(e" s*ina$ anesthesia.
T c!*a"e the e&&ecti,eness & c!binatin & "a!set"n 4.6!+ an( (e<a!ethasne
7!+ ,9s n(anset"n ?!+ *$-s (e<a!ethasne 7!+ in *"e,entin & *st *e"ati,e
na-sea an( ,!itin+' in *atients -n(e"+in+ +%naec$+ica$ s-"+e"ies -n(e" s*ina$
anesthesia.
T e,a$-ate an( "ec"( the inci(ence & a(,e"se e,ents $i#e hea(ache' (i==iness'
(")siness' &$-shin+ an( se(atin.
7.0 4ATERIAL/ A53 4ET#O3/
7.1 /OUR-E OF 3ATA
B4 *atients a+e( bet)een 34864 %ea"s )ith ASA +"a(e 1 an( 3' *ste( &" +%naec$+ica$
s-"+e"ies -n(e" s*ina$ anaesthesia at Ahe$-,a!ba Hs*ita$' attache( t M%s"e Me(ica$ A$$e+e
an( Resea"ch Instit-te' M%s"e. The st-(% **-$atin )i$$ be "an(!$% (i,i(e( int 6 +"-*s t
"ecei,e the &$$)in+ anti e!etics )ith 64 *atients in each +"-*.
1. :"-* O 8 n(anset"n 0?!+2 *$-s (e<a!ethasne 07!+2
3. :"-* R 8 "a!set"n 04.6!+2 *$-s (e<a!ethasne 07!+2
6. :"-* A8 cnt"$ 0n$% "esc-e anti8e!etic2
In6lu+!on 67!&$7!a:
N"!a$ a(-$t &e!a$e *atients a+e( bet)een 34864 %ea"s be$n+in+ t ASA c$ass 1 an( c$ass 3'
)ith b(% )ei+ht ?>864 #+s a(!itte( &" +%naec$+ica$ s-"+e"ies -n(e" s*ina$ anaesthesia'
)ith-t an% !e(ica$ i$$ness.
E86lu+!on 67!&$7!a:
/atients )ith #n)n h%*e"sensiti,it% " cnt"a8in(icatins t st-(% ("-+s.
Hist"% & na-sea' ,!itin+ " "etchin+ in 3? h-"s be&"e anaesthesia.
Recei,e( anti8e!etic ("-+s " ("-+s )ith anti8e!etic *"*e"t% (-"in+ 3? h-"s be&"e
anaesthesia.
An(itins "e.-i"in+ ch"nic *ii( -se.
Hist"% & !tin sic#ness.
/atients s-&&e"in+ &"! +ast"intestina$' $i,e" an( "ena$ (iseases.
Hist"% & *st *e"ati,e na-sea an( ,!itin+ in *"e,i-s anaesthetic e<*s-"e.
/"$n+e( E8T inte",a$ n EA:.
7.2 4$&)od+ o9 6oll$6&!on o9 da&a:
N"!a$ a(-$t *atients in a+e +"-* & 34864 %ea"s an( ASA c$ass 1 an( 3' a(!itte( &"
+%naec$+ica$ s-"+e"ies -n(e" s*ina$ anaesthesia )ith-t an% e<c$-sin c"ite"ia )i$$ be
assi+ne( "an(!$% int 6 +"-*s base( n c!*-te" +ene"ate( "an(! n-!be"s t
"ecei,e st-(% anti8e!etic ("-+ c!binatin the"a*%.
:"-* O FnG64H 8 n(anset"n 0?!+2 *$-s (e<a!ethasne 07!+2
:"-* R FnG64H 8 "a!set"n 04.6!+2 *$-s (e<a!ethasne 07!+2
:"-* A FnG64H @ cnt"$ 0n$% "esc-e anti e!etic2
The "an(!i=atin *"cess an( the i(entit% & the st-(% ("-+ a"e b$in(e( &"! the
*atients' the anaesthesi$+ists (-"in+ s-"+e"%' an( the in,esti+at"s )h c$$ect
*st *e"ati,e (ata.
A$$ the *atients )i$$ be *"e8!e(icate( )ith InCectin 0InC2 At"*ine 04.>!+2' an( InC
Mi(a=$a! 01!+2 I.1.
A$$ the *atients )i$$ "ecei,e s*ina$ anaesthesia )ith 3.>!$ & 4.>5 b-*i,acaine hea,%
an( 4.>!$ & &entan%$ 03>!c+2
In *atients in +"-*s O an( R' InC De<a!ethasne 7!+' 3!$ I1 is a(!iniste"e(
i!!e(iate$% be&"e s*ina$ anaesthesia
11
.In *atients in +"-* A' InC N"!a$ Sa$ine0NS2
3!$ I1 is a(!iniste"e( i!!e(iate$% be&"e s*ina$ anaesthesia.
In *atients in +"-* O' InC On(anset"n ?!+ I1 is a(!iniste"e( C-st be&"e the
c!*$etin & s-"+e"%
2
.
In *atients in +"-* R' InC Ra!set"n 4.6!+ I1 is a(!iniste"e( C-st be&"e the
c!*$etin & s-"+e"%.
In the cnt"$ +"-* A' InC N"!a$ Sa$ine 0NS2 3!$ I1 is a(!iniste"e( C-st be&"e the
c!*$etin & s-"+e"%. N *"*h%$actic anti e!etics a"e +i,en.
InC Dic$&enac ;>!+ IM an( a(!iniste"e( 6
th
h-"$% &" *st *e"ati,e *ain "e$ie&.
The inci(ence & na-sea an( ,!itin+ an( "etchin+ )i$$ be st-(ie( &" a *e"i( & 3? h-"s *st
*e"ati,e$%. A$$ *atients )i$$ be assesse( e,e"% h-"$% &" the &i"st 6 H-"s' 6 h-"$% &" the ne<t
6 h-"s an( 6
th
h-"$% &" s-bse.-ent 13 h-"s -sin+ the &$$)in+ /ON1 sc"in+ s%ste!
12
.
Sc"e 48 n na-sea
Sc"e 18 na-sea n$%
Sc"e 38 na-sea )ith "etchin+
Sc"e 68 ,!itin+
Na-sea is (e&ine( as a s-bCecti,e$% -n*$easant sensatin assciate( )ith an -"+e t ,!it.
Retchin+ is (e&ine( as s*as!(ic' "h%th!ic cnt"actin & "es*i"at"% !-sc$e )ith-t e<*-$sin
& +ast"ic cntents
1
.
1!itin+ is (e&ine( as &"ce&-$ e<*-$sin & +ast"ic cntents
1
.
Na-sea an( ,!itin+ cc-""in+ )ithin &i"st 6 h-"s is cnsi(e"e( as ea"$% na-sea an( ,!itin+
1
.
1!itin+ an( "etchin+ e*is(es se*a"ate( b% $ess than > !in-tes is ta#en as sin+$e e*is(e
1
.
A!*$ete "es*nse is (e&ine( as absence & na-sea' "etchin+' ,!itin+ an( n "e.-i"e!ent &
"esc-e anti8e!etic
1
.
/atients )ith !"e than t) e*is(es & na-sea an( ,!itin+ in ne h-" *e"i( a"e +i,en "esc-e
anti e!etic InC Metc$*"a!i(e 14!+ I 1.
/atients )i$$ a$s be !nit"e( &" a(,e"se e&&ects $i#e hea(ache' (i==iness' (")siness' &$-shin+
an( se(atin in the 3? h-" *st *e"ati,e *e"i(.
/TATI/TI-AL A5AL"/E/:
1a$-es )i$$ be c!*a"e( statistica$$% -sin+ Statistica$ s&t)a"e S/SS 11.> ,e"sin' Ahi8s.-a"e test. /
,a$-e &"! St-(ent T test' ne )a% ana$%sis & ,a"iance 0ANO1A2 / ,a$-e )i$$ be cnsi(e"e( si+ni&icant
)hen it is I 4.4>.
7.3 3o$+ &)$ +&ud0 7$:u!7$ an0 !n;$+&!'a&!on o7 !n&$7;$n&!on+ &o <$ 6ondu6&$d on =a&!$n&+ o7
o&)$7 an!*al+, !9 +o =l$a+$ d$+67!<$ <7!$9l0.
5O
7.4 #a+ $&)!6al 6l$a7an6$ <$$n o<&a!n$d 97o* 0ou7 !n+&!&u&!on !n 6a+$ o9 7.3>
."E/. O<&a!n$d ?6o=0 $n6lo+$d@
8. LI/T OF REFERE5-E/:
1. Wa&6)a 4F, W)!&$ AFJ /st*e"ati,e na-sea an( ,!itin+: Its eti$+%' t"eat!ent an(
*"e,entin. Anesthesi$+% 1BB3J ;;:163817?.
2. Ton' (. B, T7!6!a A. 4, -)7!+&!an -. A, F7an6$+ -, A$&$7 (. 3, A+)7a9 /. # $& al J Sciet%
&" A!b-$at"% Anesthesia +-i(e$ines &" the !ana+e!ent & *st*e"ati,e na-sea an( ,!itin+
Anesth Ana$+ 344;J14>:161>@37.
3. Ann$ 4 #$99$7nan, 3a;!d ( RoC<o&)a*. /st *e"ati,e na-sea an( ,!itin+8Ti!e &"
Ba$ance( Anti8E!esisK: B" L Anaesth. 3444J7>:6;>8;;.
4. Olando L, -a77a+6o+a F, Au$0o F (, A 4on$d$7o, 5 2u+&o, A /a$%. A!binatin &
n(anset"n an( (e<a!ethasne in the *"*h%$a<is & *st *e"ati,e na-sea an( ,!itin+. B"
L Anaesth. 1BB6J ;6:76>87?4.
5.T)o*a+ R and (on$+ 5. /"s*ecti,e' "an(!i=e(' (-b$e b$in( c!*a"ati,e st-(% &
(e<a!ethasne' n(anset"n an( n(anset"n *$-s (e<a!ethasne as *"*h%$actic
anti8 e!etic the"a*% in *atients -n(e"+in+ (a% case +%nec$+ica$ s-"+e"%. B" L Anaesth.
3441J7;:>778B3.
6. #$n%! I, Wald$7 2, T7a*$7 4 R De<a!ethasne &" the *"e,entin & *st *e"ati,e
na-sea an( ,!itin+: A E-antitati,e s%ste!atic "e,ie). Anaesth Ana$+ 3444J B4:1768B?.
7. -)!n'.L!an' #, Wu.-)ou /, Ru$0.,u$n #, 1)on'.1)$ L and T+u."! -)ao A
"an(!i=e(' (-b$e8b$in(' *a"a$$e$' c!*a"ati,e st-(% t e,a$-ate the e&&icac% an( sa&et% &
"a!set"n *$-s (e<a!ethasne inCectin &" the *"e,entin & ac-te che!the"a*%8in(-ce(
na-sea an( ,!itin+. L*n L A$in Onc$ 3414J?40?23B?@641.
8. "o+)!&aDa Fu!!, "u)! /a!&o), #!7o0o+)! TanaDa, #!d$no7! To0ooDa Ra!set"n &"
*"e,entin+ *st*e"ati,e na-sea an( ,!itin+ in )!en -n(e"+in+ +%nec$+ica$ s-"+e"%
Anaesth Ana$+ 3444J B4:?;38>.
9. /. I. ,!*, /. -. ,!*, ". #. 2a$D, /. ". OD and /. #. ,!* A!*a"isn & "a!set"n )ith
n(anset"n &" *"e,entin & *st*e"ati,e na-sea an( ,!itin+ in *atients -n(e"+in+
+%naec$+ica$ s-"+e"% B" L Anaesth 344BJ146:>?B8>6.
10. " Fu!!, " /a!&o), # TanaDa and # To0ooDa. A!*a"isn & "a!set"n an( +"aniset"n
&" *"e,entin+ *st*e"ati,e na-sea an( ,!itin+ a&te" +%nec$+ic s-"+e"%. Anesth Ana$+
1BBBJ 7B:?;6 @B.
11. ()!.(oun' Wan', /)un'.Ta! #o, (ann.Inn T%$n', -)ao./)un Tan'. The e&&ect &
ti!in+ & (e<a!ethasne a(!inist"atin n its e&&icac% as a *"*h%$actic antie!etic
&" *st*e"ati,e na-sea an( ,!itin+. Anesth Ana$+ 3444E B1: 166816B.
12. ,u+)Ca)a 2 2 , -)aD7a<o7&)0 A, A'a7Cal (, 4al!D A A!*a"ati,e st-(% & +"aniset"n
an( n(anset"n a$ne an( thei" c!binatin )ith (e<a!ethasne' &" *"e,entin & /ON1 in
!i(($e ea" s-"+e"%. The Int J of Anesth 344;J 1683.