Premedication with H1 and H2 blocking agents reduces the incidence of postoperative nausea and vomiting

Doenicke, Α.; Hoernecke, R.; Çelik, I.

doi:10.1007/s00011-004-0367-0

Cited by 15 publications

(20 citation statements)

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“…Our results are in agreement with previous studies [6,7]. The incidence of vomiting after BA was comparable to other publications e. g. Doenicke et al [6].…”

Section: Resultssupporting

confidence: 83%

“…The incidence of vomiting after BA was comparable to other publications e. g. Doenicke et al [6]. However, only early nausea was significantly less frequent (p = 0.03) after RA ( Table 1).…”

Section: Resultssupporting

confidence: 76%

“…We conclude that antihistamine prophylaxis has two benefits: significant reduction of the incidence of anaphylaxis during anaesthesia [1] and the incidence of PONV in the postoperative period [3,4,6,7].…”

Section: Resultsmentioning

confidence: 99%

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Incidence of postoperative nausea and vomiting (PONV) after general pre-anaesthetic prophylaxis with antihistamines

Duda

Krummenauer

et al. 2004

Inflammation Research

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IntroductionAs a consequence of the Mainz-Marburg trial [1], in 1999 our clinic introduced a general pre-anaesthetic prophylaxis with histamine H 1 + H 2 -receptor antagonists in order to prevent perioperative anaphylactoid reactions. Thereafter the incidence of postoperative nausea and vomiting (PONV) also seemed to be reduced compared to reported values of 30 % [2, 3]. The aetiology of PONV is complex and multi-factorial, with at least four different types of receptors involved in vomiting. Currently the drugs used for prophylaxis and/or treatment of PONV include dopaminergic, histaminic, muscarinic and serotonergic (5-HT 3 ) receptor antagonists [3 -5]. The aim of this observational trial was to quantify the efficacy of p. o. or i. v. prophylaxis with histamine H 1 + H 2 -receptor antagonists on the incidence of PONV in clinical routine. Materials and methodsBetween April and September 2002, 500 patients (206 (41.2 %) male, 294 (58.8 %) female, 18 -101 years, ASA I-IV, without major thoracic/abdominal surgery) were consecutively questioned with regard to early (£ 6 h) and late (6 -24 h) postoperative nausea (= PON I and II) Inflamm. res. 53, Supplement 1 (2004) S91-S92 and vomiting (= POV I and II). For pre-anaesthetic sedation and anxiolysis, patients received oxazepam, lorazepam or clorazepate dipotassium p. o. on the day of operation. All patients had a prophylaxis with H 1 + H 2 -receptor antagonists (dimetindene plus cimetidine) either p. o. (4 mg + 200 mg, n = 145, 29 %) at least 1 h before anaesthesia or i. v. (5 mg + 0.1 mg/kg BW, n = 355, 71 %) immediately before anaesthesia. Additionally 20 ml sodium citrate were given p. o. 10 min before balanced anaesthesia (BA, n = 386, 77.2 %) with fentanyl, thiopentone, with and without muscle relaxant and desflurane in O 2 /air or regional anaesthesia (RA, n = 114, 22.8 %, all but 4 RA were spinal cord associated). About 30 min before the end of operation, all patients received analgesia with 2.5 g novaminsulfon.The study fulfilled the ethical requirements in Germany. Data were analysed using logistic regression analysis and Chi 2 -test with p < 0.05 indicating significance. Results and discussionOur results are in agreement with previous studies [6,7]. The incidence of vomiting after BA was comparable to other publications e. g. Doenicke et al. [6]. However, only early nausea was significantly less frequent (p = 0.03) after RA ( Table 1). As nearly all our RAs were spinal cord associated, it could be speculated that a decrease in blood pressure folTable 1. Incidence of PONV after balanced (BA) and regional anaesthesia (RA). BA RA Chi 2 -test Time n = 386 (77.2 %) n = 114 (22.8 %) BA vs. RA, p-value Vomiting Early 15 (3.9 %) 4 (3.9 %) n. s. Late 20 (5.2 %) 7 (6.1 %) n. s. Early and late 30 (7.8 %) 8 (7.0 %) n. s. Nausea Early 15 (3.9 %) 0 (0 %) 0.03 Late 22 (5.7 %) 4 (3.5 %) n. s. Early and late 35 (9.1 %) 4 (3.5 %) 0.03 Early = up to 6 h post-operatively. Late = 6 -24 h post-operatively. n. s. = not significant.

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“…Our results are in agreement with previous studies [6,7]. The incidence of vomiting after BA was comparable to other publications e. g. Doenicke et al [6].…”

Section: Resultssupporting

confidence: 83%

Section: Resultssupporting

confidence: 76%

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Incidence of postoperative nausea and vomiting (PONV) after general pre-anaesthetic prophylaxis with antihistamines

Duda

Krummenauer

et al. 2004

Inflammation Research

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“…We also found evidence for an association between histamine release and POV. In addition to previously published data on the efficacy of a H 1 + H 2 antihistamine prophylaxis with regard to PONV [15,16], a recently published study clearly demonstrated a marked reduction in the incidence of PONV in patients undergoing general anaesthesia and surgery compared to reported incidences of PONV of 30 % [17]. Our results might contribute to further investigations to suggest new prophylactic antiemetics with evidence-based recommendations, using a combination of drugs acting at different receptor sites against PONV.…”

Section: Ponvmentioning

confidence: 99%

Influence of histamine release on postoperative vomiting (POV) following gynaecological laparoscopic surgery

et al. 2004

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A high incidence of plasma histamine release was demonstrated in most but not all patients with POV. The probability of POV with histamine release (0.5) was higher than without histamine release (0.3), thus histamine release was shown to be one of the contributory determinants for POV in this clinical study. Thus, patients at risk for POV may benefit from a H1 + H2-receptor antagonists prophylaxis alone or in combination with other antiemetic strategies.

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“…These drugs are frequently given before surgery because they reduce the incidence of postoperative nausea and vomiting, as well as the risk of acid reflux and pulmonary aspiration. (1,2) Moreover, H2 blocking agents are sometimes used in combination with H1antihistamines and/or corticosteroids to prevent allergic or pseudoallergic reactions prior to the administration of anesthetics or contrast media. (3,4) Here we describe the case of a patient who developed a hypersensitivity reaction to ranitidine used as premedication before general anaesthesia.…”

Section: Introductionmentioning

confidence: 99%

Hypersensitivity reaction to ranitidine: Description of a case and review of the literature

Foti

Cassano

Panebianco

et al. 2009

Immunopharmacology and Immunotoxicology

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Ranitidine is an H2-receptor antagonist which is usually well tolerated. Hypersensitivity reactions to ranitidine, as well as other H2 antihistamines, have been rarely described. We report the case of a 47-year-old woman who developed an anaphylactic reaction to ranitidine used as intravenous premedication before anesthesia induction. The patient's history revealed that previous use of oral ranitidine for a peptic ulcer disease did not cause any adverse reaction. Intradermal test with ranitidine at a dilution of 1:100 gave an intense positive reaction. The protective role of H2-receptor antagonists as premedication is still unclear and should be carefully reconsidered on the basis of the available controversial evidence and the possible risk of hypersensitivity reactions.

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Premedication with H1 and H2 blocking agents reduces the incidence of postoperative nausea and vomiting

Abstract: Premedication with H1 and H2 blocking agents significantly reduces the incidence of postoperative nausea and vomiting.

Cited by 15 publications

References 35 publications

Incidence of postoperative nausea and vomiting (PONV) after general pre-anaesthetic prophylaxis with antihistamines

Incidence of postoperative nausea and vomiting (PONV) after general pre-anaesthetic prophylaxis with antihistamines

Influence of histamine release on postoperative vomiting (POV) following gynaecological laparoscopic surgery

Hypersensitivity reaction to ranitidine: Description of a case and review of the literature

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