Efficacy of repeat intravenous dosing of ondansetron in controlling postoperative nausea and vomiting: a randomized, double-blind, placebo-controlled multicenter trial

Kovac, Anthony L.; O’Connor, Thomas A.; Pearman, Michael H.; Kekoler, Lance J.; Edmondson, Donald; Baughman, Verna L.; Angel, Jessie; Campbell, Christina; Jense, Holly G.; Mingus, Melinda L.; Shahvari, Mohammad B. G.; Creed, Mary R.

doi:10.1016/s0952-8180(99)00067-7

Cited by 145 publications

(33 citation statements)

References 13 publications

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“…Whereas complete response (no further symptoms of nausea and/or vomiting, no need for further antiemetic medication) after ondansetron 4 mg intravenously was found to be 71% in the low-risk (ondansetron-naïve) group, it was only 43% in the high-risk group. This finding was previously reported by Kovac et al 17 and suggests that established PONV should be treated with a rescue antiemetic acting via a different mechanism. Of note is the comparable complete response rate between patients receiving ondansetron 4 mg intravenously in the first two hours after recovery and patients receiving ondansetron ODT 4 mg that is known to have a bio-availabilty of only 60% later on the ward.…”

Section: Efficacy Of Antiemetic Treatmentsupporting

confidence: 85%

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

Can J Anesth/J Can Anesth

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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.

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Section: Efficacy Of Antiemetic Treatmentsupporting

confidence: 85%

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

Can J Anesth/J Can Anesth

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“…Currently, 5-HT 3 receptor antagonists such as ondansetron are widely used for prevention and treatment of PONV and although these agents have a significant effect, over 35% of patients treated with ondansetron may still experience PONV [4,5]. We hypothesised that polymorphism in the adenosine triphosphate-binding cassette subfamily B member 1 (ABCB1), an encoding gene of transporter for ondansetron in the brain-blood barrier [6], would contribute to such inter-individual variation.…”

Section: Discussionmentioning

confidence: 99%

“…The incidence ranges between 20% and 30%, but is as high as 80% in high-risk patients [1] and may cause significant complications [2]. Although the exact mechanism of PONV is not clear, it is known that the chemoreceptor trigger zone in the area postrema plays an important role, in which the 5-hydroxytryptamine type-3 (5-HT 3 ) receptor is involved in the occurrence of PONV [3].Currently, 5-HT 3 receptor antagonists such as ondansetron are widely used for prevention and treatment of PONV and although these agents have a significant effect, over 35% of patients treated with ondansetron may still experience PONV [4,5]. We hypothesised that polymorphism in the adenosine triphosphate-binding cassette subfamily B member 1 (ABCB1), an encoding gene of transporter for ondansetron in the brain-blood barrier [6], would contribute to such inter-individual variation.…”

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confidence: 99%

Association of ABCB1 polymorphisms with the efficacy of ondansetron for postoperative nausea and vomiting

Choi

Lee

et al. 2010

Anaesthesia

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SummaryWe investigated whether the 2677G>T ⁄ A and 3435C>T polymorphisms of adenosine triphosphate-binding cassette subfamily B member 1 (ABCB1) affect the efficacy of ondansetron to prevent postoperative nausea and vomiting. One hundred and ninety-eight patients undergoing general anaesthesia were enrolled. Thirty minutes before the end of surgery, 0.1 mg.kgondansetron was administered intravenously. The incidence of postoperative nausea and vomiting was compared between genotypes in the 2677G>T ⁄ A and 3435C>T polymorphisms of ABCB1. The incidence of postoperative nausea and vomiting was lower in patients with the 2677TT genotype (TT vs Non-TT = 25.9% vs 53.0%, p = 0.01) and 3435TT genotype (CC + CT vs TT = 52.6% vs 21.7%, p = 0.01) during the first 2 h after surgery. There were no significant differences in the incidence of postoperative nausea and vomiting between the different genotype groupings during period between 2 and 24 h after surgery. In conclusion, ABCB1 genotypes may be a clinical predictor of responsiveness for ondansetron. Postoperative nausea and vomiting (PONV) is a common and distressing complication in patients undergoing general anaesthesia. The incidence ranges between 20% and 30%, but is as high as 80% in high-risk patients [1] and may cause significant complications [2]. Although the exact mechanism of PONV is not clear, it is known that the chemoreceptor trigger zone in the area postrema plays an important role, in which the 5-hydroxytryptamine type-3 (5-HT 3 ) receptor is involved in the occurrence of PONV [3].Currently, 5-HT 3 receptor antagonists such as ondansetron are widely used for prevention and treatment of PONV and although these agents have a significant effect, over 35% of patients treated with ondansetron may still experience PONV [4,5]. We hypothesised that polymorphism in the adenosine triphosphate-binding cassette subfamily B member 1 (ABCB1), an encoding gene of transporter for ondansetron in the brain-blood barrier [6], would contribute to such inter-individual variation.In a previous study, the 3435C>T single nucleotide polymorphism of ABCB1 was associated with the efficacy of 5-HT 3 receptor antagonists for chemotherapy-induced nausea and vomiting [7]. Therefore, we investigated whether the 2677G>T ⁄ A, and 3435C>T polymorphisms of ABCB1 affect the efficacy of ondansetron in preventing PONV in patients undergoing general anaesthesia. MethodsThis study was approved by the Institutional Review Board of Yonsei University Hospital. Written informed consent was obtained from each patient. One hundred and ninety-eight adult patients, of ASA physical status 1-2, undergoing laparoscopic cholecystectomy were enrolled in this study. Patients with a history of drug abuse, known hypersensitivity to 5-HT 3 receptor antagonist, body mass index > 30 kg.m , hepatic or renal disease or who had used antiemetics within the 24 h before the study were excluded. Before surgery, all patients were interviewed about their medical history including tobacco use, presence of PONV and motion sic...

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“…138 A drug acting at a different receptor might be more effective in this case (IVB). 139 There are some data from chemotherapy induced nausea and vomiting to suggest that granisetron might be efficacious for treating patients who fail ondansetron prophylaxis.…”

Section: Combination Antiemetic Therapy and Multimodal Approachmentioning

confidence: 99%

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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Efficacy of repeat intravenous dosing of ondansetron in controlling postoperative nausea and vomiting: a randomized, double-blind, placebo-controlled multicenter trial

Cited by 145 publications

References 13 publications

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

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

Association of ABCB1 polymorphisms with the efficacy of ondansetron for postoperative nausea and vomiting

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

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