الفهرس 
Nausea//Rettchiing//Vomiittiing
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Abstract
and Conclusion/s Postoperative nausea and vomiting (PONV) is a common complication of laparoscopic procedures. There is no single cause for PONV, thus, a combination of antiemetics may be more effective than a single antiemetic. Adults at moderate or high risk of PONV should receive combination therapy with drugs from different classes, as efficacy is optimized when a combination of drugs with different mechanisms of action is administered .Ninety nonsmoker females scheduled for gynecologic surgeries were randomized to receive ondansetron 4 mg at end of surgery, IV haloperidol 1 mg at end of surgery, or midazolam 2 mg 30 minutes before end of surgery. Each group received dexamethasone 4 mg after induction of anesthesia. Demographic data and hemodynamics were evaluated .Nausea, vomiting, need for rescue antiemetics, sedation level and pain intensity were evaluated. There was no intergroup difference in any measurement.Ondansetron, haloperidol and midazolam subjects had complete prophylactic rate (86.7% ,80% and 83.3%),respectively. Regarding rescue antiemetics, no significant difference was found between the three groups. Ondansetron had preventive effects on PONV similar to midazolam or haloperidol in high-risk patients after gynecological laparoscopic surgery.Conclusion In the studied surgical population, PONV prophylaxis with haloperidol 1 mg or midazolam 2 mg, both combined with dexamethasone 4 mg, is comparable to ondansetron 4 mg combined with dexamethasone 4 mg as regard the efficacy and complications Haloperidol and midazolam have similar safety and efficacy for PONV prophylaxis as ondansetron in patients undergoing gynecologic laparoscopic surgeries without increasing recovery time and the level of sedation. Haloperidol or midazolam can be used as alternative to ondansetron, which is considered the gold standard for PONV prophylaxis .Recommendation The use of combined haloperidol and dexamethasone or midazolam and dexamethasone can replace the use of ondansetron combined with dexamethasone in PONV prophylaxis in high risk patients Limitation/s of the study This prospective randomized controlled study can’t be managed as double blinded study. Different drugs were given at different times during the operation. Ondansetron and haloperidol were given at the end of surgery ,while midazolam was given 30 minutes before the end of surgery. As ,the peak effect in ondansetron is 10 minutes. The time to peak plasma concentration from IV injection in haloperidol is five to 15 minutes ,while onset of sedative action in midazolam is 2 minutes and last for 10 minutes. That is why this study can’t be double blinded study.