Double-blind, Randomized Comparison of Ondansetron and Intraoperative Propofol to Prevent Postoperative Nausea And Vomiting

Gan, Tong J.; Ginsberg, Brian; Grant, Alan; Glass, Peter S. A.

doi:10.1097/00000542-199611000-00011

Cited by 175 publications

(64 citation statements)

References 41 publications

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“…The recommended dose for dimenhydrinate is 1 to 2 mg·kg -1 in adults and 0.5 mg·kg -1 in children (IIA). 30 The NNT (95% CI) to stay completely free from nausea was 8 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) during the first six hours postoperatively and 6 (3-33) for the period from zero to 48 hr. For vomiting, the NNT (95% CI) was 7 (4-50) and 5 (3)(4)(5)(6)(7)(8) for the early and the 48-hr period respectively.…”

Section: Other Older Generation Antiemeticsmentioning

confidence: 99%

“…[83][84][85] In one study, this technique was equally efficacious to ondansetron 4 mg in the prevention of PONV (IIIA). 18 The antiemetic effect of propofol is most pronounced in the early postoperative period. It is not useful for PONV prophylaxis if given only as a bolus for induction of anesthesia (IIA).…”

Section: B Propofolmentioning

confidence: 99%

“…Identification of patients at high risk for PONV allows targeting prophylaxis to those who will benefit most from it. Patient, anesthesia, and surgery related risk factors have been identified [8][9][10][11][12][13][14][15][16][17][18] (Table II). There is controversy regarding a number of previously reported risk factors.…”

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confidence: 99%

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

Habib

Gan

2004

Can J Anesth/J Can Anesth

196

106

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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

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Section: Other Older Generation Antiemeticsmentioning

confidence: 99%

Section: B Propofolmentioning

confidence: 99%

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

Habib

Gan

2004

Can J Anesth/J Can Anesth

196

106

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“…PONV after lower extremity TJA has a reported incidence of 20 to 83% [14,21]. Various antiemetic agents control PONV [8,12,13,15,16]. In addition to the discomfort and emotional distress inflicted on the patient, PONV can be immobilizing, potentially increasing the risk of thromboembolic disease, interfering with physical therapy and delaying hospital discharge [1,11,23,25,31].…”

Section: Introductionmentioning

confidence: 99%

Antiemesis After Total Joint Arthroplasty: Does a Single Preoperative Dose of Aprepitant Reduce Nausea and Vomiting?

DiIorio

Sharkey

Hewitt

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Background Postoperative nausea and vomiting (PONV) is frequent after joint arthroplasty; in addition to causing patient distress, it interferes with early mobilization and hospital discharge. Various antiemetic agents reduce PONV, but their action is limited by a short half-life. Aprepitant, an antiemetic developed for patients receiving chemotherapy, has a duration of action much longer than other antiemetics. Questions/purposes We asked whether a single dose of preoperative aprepitant (40 mg orally) reduced postoperative nausea and vomiting after THA or TKA. Methods Fifty patients who received a preoperative dose of aprepitant (study group) were matched demographically to 50 patients who did not receive aprepitant (control group) from a group of patients undergoing THA or TKA. Patients' charts were reviewed to identify episodes of PONV, number of doses of antiemetics needed for breakthrough PONV, and length of stay. Aprepitant side effects, and complications. Results Aprepitant reduced the percentage of patients with PONV (39% of study and 70% of control patients). Moderate or severe PONV occurred in 22% of study and 40% of control patients. The number of episodes of PONV during hospitalization was 2.9 for the control group and 1.6 for the study group. Postoperatively, the control group required on average 1.3 doses of ondansetron compared with 0.6 doses for the study group. Hospital length of stay was reduced from 3.3 days for the control group and to 2.3 days for the study group. Conclusions These data suggest a single preoperative dose of aprepitant reduces the number of episodes and severity of PONV, the need for additional antiemetics, and the length of stay. Level of Evidence Level II, prognostic study. See guidelines for authors for a complete description of levels of evidence.

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“…Propofol rapidly and reliably induces anesthesia (Tagliente, 1997), is believed by some to reduce postoperative nausea and vomiting when used as both an induction and maintenance agent (Borgeat, WilderSmith, Saiah, & Rifat, 1992;Gan, Ginsberg, Grant, & Glass, 1996;Hamunen, Vaalamo, & Mauneksela, 1997;Klockgether-Radke, Piorek, Crozier, & Kettler, 1996;Myles, Hendrata, Bennett, Langley, & Buckland, 1996;Sung et al, 1991) but that result is controversial (Zestos et al, 1997). Propofol may interact with droperidol to increase nausea (Wagner, Berman, Devitt, & O'Hara, 1994).…”

Section: Problem Of Reducing Costsmentioning

confidence: 99%

Comparison Of The Direct Costs, Length Of Recovery, And Incidence Of Post Operative Anti Emetic Use After Anesthesia Induction With Propofol Or A 1:1 Mixture Of Thiopental And Propofol

Killpack¹

1999

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Public reporting burden for the collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to a penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. The modern anesthesia provider must consider drug costs as important as benefits and risks when choosing which drug to use in an anesthetic. Thiopental has been the gold standard for an IV induction drug although propofol shows a better recovery profile with less post-operative nausea and vomiting, but at a higher cost. We attempted to determine if a 1:1 volume mixture of thiopental and propofol would show a similar recovery profile compared to propofol alone, but at a lower cost. This study examined the records of 212 surgery patients receiving propofol (n=82) or a 1:1 mixture (n=130) for demographic, peri-operative, PACU recovery, anti-emetic use, and cost data. We found that the propofol group had significantly more females, postoperative anti-emetic use, and induction drug costs, while the 1:1 mixture group had significantly longer surgery and anesthesia times. Mean post-operative anti-emetic drug costs were statistically significant (P<0.05) at $3.15 for the propofol group and $1.08 for the 1:1 mixture group. The mean cost of induction for the propofol group was $27.31 and $14.31 for the 1:1 mixture group, a statistically significant (P<0.05) difference of $13.09. The average recovery time for the propofol group was 134 minutes and cost $1205.37, and for the 1:1 mixture group 147 minutes and cost $1320.03. Thus, the difference in PACU charges was $114.66. This research suggests that the 1:1 mixture of thiopental and propofol produced a similar recovery profile to propofol alone, but at a lower direct cost. This study supported previous work, and recommends that further research be done to confirm its findings. ix ACKNOWLEDGEMENT SUBJECT TERMS

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Double-blind, Randomized Comparison of Ondansetron and Intraoperative Propofol to Prevent Postoperative Nausea And Vomiting

Cited by 175 publications

References 41 publications

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

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

Antiemesis After Total Joint Arthroplasty: Does a Single Preoperative Dose of Aprepitant Reduce Nausea and Vomiting?

Comparison Of The Direct Costs, Length Of Recovery, And Incidence Of Post Operative Anti Emetic Use After Anesthesia Induction With Propofol Or A 1:1 Mixture Of Thiopental And Propofol

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