Ondansetron is no More Effective than Supplemental Intraoperative Oxygen for Prevention of Postoperative Nausea and Vomiting

Abstract

Supplemental oxygen reduces the risk of postoperative nausea and vomiting (PONV) as well or better than 8 mg of ondansetron. Because oxygen is inexpensive and essentially risk-free, supplemental oxygen is a preferable method of reducing PONV.

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

“…102 In two studies by one group, oxygen supplementation (80%) intraoperatively or both intraoperatively and for two hours postoperatively was effective in achieving a significant reduction in the incidence of PONV compared to patients receiving 30% oxygen (IIIB). 103,104 These findings were not confirmed in a more recent study in females undergoing ambulatory gynecologic surgery. In this study, 80% oxygen was given intraoperatively and for up to one hour postoperatively.…”

“…2,[8][9][10][11][12][13] The use of large doses of neostigmine (> 2.5 mg) increases the risk of PONV. 14 Other strategies that might reduce the incidence of PONV include the use of supplemental intraoperative oxygen (FIO 2 = 0.8), 103,104 adequate hydration especially using colloids, 106,107 anxiolysis with benzodiazepines, 122 and the use of α 2 -agonists. 101,102 Scuderi et al tested a multimodal approach to the management of PONV in females undergoing outpatient laparoscopy.…”

Acupressure and ondansetron for postoperative nausea and vomiting after laparoscopic cholecystectomy

“…The latter advantage has been negated by PONV, which is turning out to be the leading cause of unexpected re-admission after day surgery. 13,14 The incidence of PONV has been reported to be as high as 53-72%. 15 After laparoscopic cholecystectomy up to 70% patients have PONV if they are not on any antiemetic prophylaxis.…”

Atelectasias durante anestesia: fisiopatologia e tratamento

“…Relatos entre a associação de concentrações elevadas de oxigênio inspirado e colapso pulmonar têm sido descritos há pelo menos 50 anos 8 . Apesar de os efeitos benéficos serem atribuídos ao uso da concentração alta de oxigênio durante a anestesia, como a redução de náusea e vômito pós-operatório 37 , ao aumento das respostas pró-inflamató-rias e atividade antimicrobiana dos macrófagos alveolares 38 , à possível diminuição na infecção da ferida cirúrgica no pós-operatório 39 e à prevenção de episódios de hipoxemia, as atelectasias desenvolvidas no período intra-operatório não são prontamente revertidas no pós-operatório e podem persistir por vários dias, aumentando o tempo de ventilação mecânica, a necessidade de fisioterapia respiratória, a duração da internação hospitalar e os custos. Avaliando cautelosamente esses dados, evidências atuais não sugerem que possíveis benefícios do uso de altas concentrações de oxigênio possam contrabalançar as conseqüências deleté-rias de complicações pulmonares pós-operatórias.…”

“…There have been reports in the literature associating high inspired fractions of oxygen and pulmonary collapse for at least fifty years 8 . Although some benefits have been attributed to the use of high oxygen concentrations during anesthesia, such as reduction in postoperative nausea and vomiting 37 , increase in pro-inflammatory responses and antimicrobiotic activity of alveolar macrophages 38 , possible reduction in postoperative infection of the surgical wound 39 and prevention of episodes of hypoxemia, postoperative atelectasis do not reverse immediately and might persist for several days increasing the time of mechanical ventilation required, the need of respiratory therapy, increased length of hospita-lization and health care costs. Weighing those data carefully, current evidence does not indicate that the possible benefits of the use of high oxygen concentrations can overcome the detrimental consequences of postoperative pulmonary complications.…”