A quantitative systematic review of ondansetron in treatment of established postoperative nausea and vomiting

196

106

P Pu ur rp po os se e: : To provide evidence-based guidelines for the prophylaxis and treatment of postoperative nausea and vomiting (PONV).S So ou ur rc ce e: : Literature from randomized controlled trials, systematic reviews, logistic regression analyses and expert opinion in the management of PONV.P Pr ri in nc ci ip pa al l f fi in nd di in ng gs s: : The etiology of PONV is multifactorial. Patient, anesthesia, and surgery related risk factors have been identified. Universal PONV prophylaxis is not cost-effective. Identification of patients at high-risk of PONV allows targeting prophylaxis to those who will benefit most from it. No prophylaxis is needed for patients at low risk for PONV. For patients at moderate risk for PONV, prophylaxis using a single antiemetic or a combination of two agents should be considered. Double and triple antiemetic combinations should be considered for patients at high risk for PONV. Furthermore, a multimodal approach should be adopted incorporating steps to keep the baseline risk of PONV low. The optimum cost-effective approach to the management of PONV will differ between an ambulatory centre and an inpatient hospital setting. For the treatment of established PONV in patients who failed prophylaxis, patients should not receive a repeat dose of the prophylactic antiemetic. Rather, a drug acting at a different receptor should be used. Beyond six hours after surgery, patients can be treated with any of the agents used for prophylaxis, except dexamethasone and transdermal scopolamine.C Co on nc cl lu us si io on n: : PONV are common after anesthesia and surgery. We provided evidence-based guidelines for the management of this problem based on the available literature. Objectif : Énoncer des lignes de conduite fondées sur des données probantes pour la prévention et le traitement des nausées et des vomissements postopératoires (NVPO). Source : Les publications d'essais contrôlés et randomisés, les études méthodiques, les analyses de régression logistique et l'opinion d'experts sur le traitement des NVPO. Constatations principales : L'origine des NVPO est multifactorielle. Les facteurs de risque reliés au patient, à l'anesthésie et au type de chirurgie sont connus. La prévention universelle des NVPO n'est pas rentable. L'identification des patients à haut risque de NVPO permet

Section: Combination Antiemetic Therapy and Multimodal Approachmentioning

confidence: 99%

Evidence-based management of postoperative nausea and vomiting: a review

Habib

Gan

2004

196

106

“…This is in accordance with the results of a meta-analysis suggesting that even 1 mg of ondansetron iv is effective for the treatment of established PONV. 18 In conclusion, the use of a prophylactic strategy based on a simplified risk score reduces the overall institutional rate of PONV by reducing the incidence of PONV in the high-risk group. However, when classifying patients into "low-risk" and "high-risk" groups for the management of PONV the number of highrisk patients experiencing PONV remains unacceptably high when ondansetron is used as the single antiemetic.…”

Section: Efficacy Of Antiemetic Treatmentmentioning

confidence: 99%

Une approche préventive adaptée aux risques réduit l’incidence générale de nausées et de vomissements postopératoires en milieu hospitalier

Biedler

Wermelt

Kunitz

et al. 2004

P Pu ur rp po os se e: : Routine prophylactic antiemetic treatment of surgical patients appears justified only in case of an increased risk of postoperative nausea and vomiting (PONV). The objective of this investigation was to assess the feasibility and efficacy of a dichotomized risk score adapted management of PONV based on ondansetron prophylaxis and treatment with respect to the overall institutional rate of PONV. M Me et th ho od ds s: :After estimating the individual PONV risk by a simplified score, 162 adult patients scheduled for elective surgery received either 4 mg ondansetron intravenously (two to four risk factors = high-risk) or no prophylaxis (zero to one risk factor = low-risk). For antiemetic treatment ondansetron was given intravenously and orally. Incidence of PONV was recorded during the first 24 hr after recovery.

“…The typical response rate to placebo (saline) treatment for established PONV ranges from 14 to 20%. 13 According to theories of Traditional Chinese Medicine, effective points in treatment of disease are always connected to meridians in the human body.…”

Section: Statisticsmentioning

confidence: 99%

P6 acupressure increases tolerance to nauseogenic motion stimulation in women at high risk for PONV

Alkaissi

Ledin

Ödkvist

et al. 2005

P Pu ur rp po os se e: : In a previous study we noticed that P6 acupressure decreased postoperative nausea and vomiting (PONV) more markedly after discharge. As motion sickness susceptibility is increased by, for example, opioids we hypothesized that P6 acupressure decreased PONV by decreasing motion sickness susceptibility. We studied time to nausea by a laboratory motion challenge in a group of volunteers, during P6 and placebo acupressure.M Me et th ho od ds s: : 60 women with high and low susceptibilities for motion sickness participated in a randomized and double-blind study with an active P6 acupressure, placebo acupressure, and a control group (n = 20 in each group). The risk score for PONV was over 50%. The motion challenge was by eccentric rotation in a chair, blindfolded and with chin to chest movements of the head. The challenge was stopped when women reported moderate nausea. Symptoms were recorded. R Re es su ul lt ts s: : Mean time to moderate nausea was longer in the P6 acupressure group compared to the control group. P6 acupressure = 352 (259-445), mean (95% confidence interval) in seconds, control = 151 (121-181) and placebo acupressure = 280 (161-340); (P = 0.006). No difference was found between P6 and placebo acupressure or placebo acupressure and control groups. Previous severity of motion sickness did not influence time to nausea (P = 0.107). The cumulative number of symptoms differed between the three groups (P < 0.05). Fewer symptoms were reported in the P6 acupressure compared to the control group P < 0.009. Overall, P6 acupressure was only marginally more effective than placebo acupressure on the forearms. C Co on nc cl lu us si io on n: : In females with a history of motion sickness P6 acupressure increased tolerance to experimental nauseogenic stimuli, and reduced the total number of symptoms reported. OSTOPERATIVE nausea and vomiting (PONV) can be exacerbated by movement such as transport on a trolley, change in position in bed and, after day-case surgery, transport home or activity at home. Objectif1 A history of motion sickness is also an independent predictor of PONV.2 Recent evidence suggests that P6 acupressure may decrease symptoms of motion sickness, 3 and that these effects may be particularly beneficial after day case surgery. 4,5 Could it be that P6 stimulation is mainly effective on movement-induced nausea?The main signs and symptoms of motion sickness are nausea, pallor, cold sweating, and vomiting. However, many other symptoms of motion sickness are reported to varying degrees. These include apathy, general discomfort, headache, stomach awareness, increased salivation, fatigue, drowsiness, depression, warmth, dizziness, yawning, cardiac palpitations, and inability to concentrate or perform tasks. 6,7 We hypothesized that women at high risk for PONV would benefit from P6 acupressure administered prior to nauseogenic stimuli. The primary outcome was the time to moderate nausea (3 or more on a Lickert type scale 0-6) provoked by head movements in an eccentrically rotating c...