The timing of haloperidol administration does not affect its prophylactic antiemetic efficacy

Abstract

Purpose: Postoperative nausea and vomiting (PONV) occurs frequently after general anesthesia. We evaluated the timing of 2 mg iv doses of haloperidol on the efficacy of this drug as a prophylactic antiemetic for PONV. Methods: Ninety-four non-smoking female patients with a history of motion sickness and/or PONV (Apfel's simplified risk score = 3; predicted incidence of PONV = 60%) were eligible to participate in this randomized, double-blind study. Patients were divided into two groups. Group 1 patients received haloperidol 2 mg iv during induction of anesthesia. Group 2 patients received haloperidol 2 mg iv approximately 30 min before the end of surgery. The occurrence of nausea and vomiting, nausea scores, pain scores, sedation levels, and adverse effects (cardiac arrhythmias, and extrapyramidal effects) were recorded by a trained, blinded investigator. Results:The percentages of patients who experienced PONV in the first 24 hr were similar for the two groups (Group 1 = 30%; Group 2 = 26%, P = 0.645). The incidence of PONV was significantly smaller in both groups than that predicted (60%) according to the patients' underlying risks (Group 1, P = 0.004; Group 2, P = 0.001). Nausea scores, pain scores, sedation scores, emergence times, and time to first rescue treatment were similar in the two groups. No adverse effects attributable to the study medication were observed. Conclusion:The timing of administration of haloperidol 2 mg iv does not influence its antiemetic efficacy. The recovery profiles were also similar whether haloperidol was administered at the start, or at the end of surgery. Reports of Original InvestigationsThe timing of haloperidol administration does not affect its prophylactic antiemetic efficacy Address correspondence to: Dr. Yi Lee, Department of Anesthesiology, Buddhist Tzu-Chi Medical Center, Buddhist Tzu-Chi University School of Medicine, No. 707, Section 3, Chung-Yang Road, Hualien, Taiwan, ROC. E-mail: drleeyi2001@yahoo.com.tw There were no direct funding sources (departmental, hospital, institutional, commercial) supporting this work. There are no commercial or non-commercial affiliations that were, or might be perceived to be, a conflict of interest amongst the authors relating to publication of the data. The clinical trial registration number (Buddhist Tzu Chi Medical Center): IRB094-41.

Comparison of Prophylactic Antiemetic Efficacy of Haloperidol and Granisetron for the Prevention of Postoperative Nausea and Vomiting Followed by Laparoscopic Surgeries

“…34 In contrast Yang YL et al suggested that the timing of administration of haloperidol 2 mg IV did not influence its antiemetic efficacy. 35 The recovery profiles were also similar whether haloperidol was administered at the start or at the end of surgery. In our study, incidence of nausea in Haloperidol group was 4 cases (13.3%), all of mild intensity.…”

Low Doses of Haloperidol Combined With Ondansetron Are not Effective for Prophylaxis of Postoperative Nausea and Vomiting in Susceptible Patients

“…An in-depth review of studies since the 1970s shows that higher doses of haloperidol have demonstrated greater effectiveness. [27][28][29][30] Various studies using haloperidol 1 mg have shown that it is effective 15,28,31,32 but other studies have not achieved the same results. 33,34 Even so, clinical guidelines recommend the use of haloperidol 1 or 2 mg in combination.…”

“…In the O&Hal1 group, 42% (CI: 32-53) of patients suffered from EE vs 20% (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29), 25% (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) and 30% in groups O&Dex, O&Hal2 and O&Dro respectively (P=.005). These significant differences were observed in groups O&Dex and O&Hal1 from the 6 to 12 h interval ( Table 2).…”

Haloperidol as prophylactic treatment for postoperative nausea and vomiting: Systematic literature review

“…Six of the trials specify the development and blind nature of the randomization process. [26][27][28][29][30][31][32][33][34] The quality of the experiments and the amount of information reported in the articles improved according to the year of publication, probably because of the development of checklists that facilitate the job of the researchers in organizing and assembling the reports of the trials. The articles included in this systematic review are average to high quality.…”

“…[8][9][10] There is now a renewed interest in the use of haloperidol for the management of PONV, because it is an effective, safe and low cost alternative, with theoretical advantages such as an extended half-life with a delayed potential protective effect. 11,12 A meta-analysis published by Buttner et al in 2004 7 evaluated the effectiveness of haloperidol under varying scenarios, including PONV, showing adequate effectiveness with no relationship between the dose used and the scope of the effect. Since then, new evidence has been found 13,14 evaluating haloperidol's effectiveness [15][16][17][18][19][20][21] and so we considered it appropriate to undertake a new systematic review to assess the effectiveness and safety of haloperidol as a prophylactic agent in PONV.…”