Aprepitant’s Prophylactic Efficacy in Decreasing Postoperative Nausea and Vomiting in Morbidly Obese Patients Undergoing Bariatric Surgery

Sinha, Ashish; Singh, Preet Mohinder; Williams, N; Ochroch, E. Andrew; Goudra, Basavana

doi:10.1007/s11695-013-1065-1

Cited by 63 publications

(56 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The full-text publications of these studies were examined at detail, and 7 trials were further excluded: 2 studies were not RCTs 30 , 31 ; one study described ongoing trials 32 ; one study used NK-1R antagonists for patients who already developed nausea or vomiting 36 ; one study investigated the efficacy of NK-1R antagonists on postdischarge nausea and vomiting 33 ; and 2 studies compared NK-1R antagonist alone to that combined with additional antiemetics. 34 , 35 We finally included 14 RCTs 8 , 13 – 15 , 20 – 29 in this systematic review and meta-analysis (Figure 1 ).…”

Section: Resultsmentioning

confidence: 99%

Neurokinin-1 Receptor Antagonists in Preventing Postoperative Nausea and Vomiting

Liu

Zhang

et al. 2015

Medicine

View full text Add to dashboard Cite

Newly developed neurokinin-1 receptor (NK-1R) antagonists have been recently tried in the prevention of postoperative nausea and vomiting (PONV). This systematic review and meta-analysis was conducted to explore whether NK-1R antagonists were effective in preventing PONV.The PRISMA statement guidelines were followed. Randomized clinical trials (RCTs) that tested the preventive effects of NK-1R antagonists on PONV were identified by searching EMBASE, CINAHL, PubMed, and the Cochrane Library databases followed by screening. Data extraction was performed using a predefined form and trial quality was assessed using a modified Jadad scale. The primary outcome measure was the incidence of PONV. Meta-analysis was performed for studies using similar interventions. Network meta-analysis (NMA) was conducted to compare the anti-vomiting effects of placebo, ondansetron, and aprepitant at different doses.Fourteen RCTs were included. Meta-analysis found that 80 mg of aprepitant could reduce the incidences of nausea (3 RCTs with 224 patients, pooled risk ratio (RR) = 0.60, 95% confidence interval (CI) = 0.47 to 0.75), and vomiting (3 RCTs with 224 patients, pooled RR = 0.13, 95% CI = 0.04 to 0.37) compared with placebo. Neither 40 mg (3 RCTs with 1171 patients, RR = 0.47, 95% CI = 0.37 to 0.60) nor 125 mg (2 RCTs with 1058 patients, RR = 0.32, 95% CI = 0.13 to 0.78) of aprepitant showed superiority over 4 mg of ondansetron in preventing postoperative vomiting. NMA did not find a dose-dependent effect of aprepitant on preventing postoperative vomiting.Limited data suggested that NK-1R antagonists, especially aprepitant were effective in preventing PONV compared with placebo. More large-sampled high-quality RCTs are needed.

show abstract

Section: Resultsmentioning

confidence: 99%

Neurokinin-1 Receptor Antagonists in Preventing Postoperative Nausea and Vomiting

Liu

Zhang

et al. 2015

Medicine

View full text Add to dashboard Cite

show abstract

“…Although the neurotransmitter involved at both levels is substance P, aprepitant may have deferential affinity for receptors at both these levels, resulting in a better effect on vomiting than on nausea prevention. Many trials have highlighted such a possibility,25 but further research on the pharmacological properties of aprepitant is needed before any conclusions can be made.…”

Section: Discussionmentioning

confidence: 99%

Aprepitant for postoperative nausea and vomiting: a systematic review and meta-analysis

Singh

Borle

Rewari

et al. 2015

Postgraduate Medical Journal

Self Cite

View full text Add to dashboard Cite

Postoperative nausea and vomiting (PONV) is an important clinical problem. Aprepitant is a relatively new agent for this condition which may be superior to other treatment. A systematic review was performed after searching a number of medical databases for controlled trials comparing aprepitant with conventional antiemetics published up to 25 April 2015 using the following keywords: 'Aprepitant for PONV', 'Aprepitant versus 5-HT3 antagonists' and 'NK-1 versus 5-HT3 for PONV'. The primary outcome for the pooled analysis was efficacy of aprepitant in preventing vomiting on postoperative day (POD) 1 and 2. 172 potentially relevant papers were identified of which 23 had suitable data. For the primary outcome, 14 papers had relevant data. On POD1, 227/2341 patients (9.7%) patients randomised to aprepitant had a vomiting episode compared with 496/2267 (21.9%) controls. On POD2, the rate of vomiting among patients receiving aprepitant was 6.8% compared with 12.8% for controls. The OR for vomiting compared with controls was 0.48 (95% CI 0.34 to 0.67) on POD1 and 0.54 (95% CI 0.40 to 0.72) on POD2. Aprepitant also demonstrated a better profile with a lower need for rescue antiemetic and a higher complete response. Efficacy for vomiting prevention was demonstrated for 40 mg, 80 mg and 125 mg without major adverse effects. For vomiting comparison there was significant unexplainable heterogeneity (67.9% and 71.5% for POD1 and POD2, respectively). We conclude that (1) aprepitant reduces the incidence of vomiting on both POD1 and POD2, but there is an unexplained heterogeneity which lowers the strength of the evidence; (2) complete freedom from PONV on POD1 is highest for aprepitant with minimum need for rescue; and (3) oral aprepitant (80 mg) provides an effective and safe sustained antivomiting effect.

show abstract

“…Clinically significant respiratory depression increases proportionately with BMI and severity of OSA [71]. Worsening of OSA [72], postoperative respiratory obstruction [73], acute hypoxemia/hypercarbia, [74] delayed recovery [75], delayed discharge [76], increased postoperative nausea vomiting [77], and increased ICU admission rates [19] are among the few complications that have been directly attributed to perioperative opioid use in obese patients. Thus, it is prudent to use opioid sparing Bmultimodal analgesia^wher-ever feasible [78].…”

Section: Is There An Ideal Analgesic Regimen? Transfer From Pacu To Fmentioning

confidence: 99%

Controversies in Perioperative Anesthetic Management of the Morbidly Obese: I Am a Surgeon, Why Should I Care?

Singh

2015

OBES SURG

Self Cite

View full text Add to dashboard Cite

Over the last four decades, as the rates of obesity have increased, so have the challenges associated with its anesthetic management. In the present review, we discuss perioperative anesthesia management issues that are modifiable by the early involvement of the surgical team. We sum up available evidence or expert opinion on issues like patient positioning, postoperative analgesia, and the effect of continuous positive airway pressure (CPAP) ventilation on surgical anastomosis. We also address established predictors of higher perioperative risk and suggest possible management strategies and concerns of obese patients undergoing same day procedures. Finally, a generalized pharmacological model relevant to altered pharmacokinetics in these patients is presented.

show abstract

Aprepitant’s Prophylactic Efficacy in Decreasing Postoperative Nausea and Vomiting in Morbidly Obese Patients Undergoing Bariatric Surgery

Abstract: In morbidly obese patients undergoing laparoscopic bariatric surgery, addition of aprepitant to ondansetron can significantly delay vomiting episodes simultaneously lowering the incidence of postoperative vomiting.

Cited by 63 publications

References 19 publications

Neurokinin-1 Receptor Antagonists in Preventing Postoperative Nausea and Vomiting

Neurokinin-1 Receptor Antagonists in Preventing Postoperative Nausea and Vomiting

Aprepitant for postoperative nausea and vomiting: a systematic review and meta-analysis

Controversies in Perioperative Anesthetic Management of the Morbidly Obese: I Am a Surgeon, Why Should I Care?

Contact Info

Product

Resources

About