Tropisetron zur Prophylaxe von Übelkeit und Erbrechen in der postoperativen Phase

Kranke, Peter; Eberhart, Leopold; Apfel, Christian C.; Broscheit, Jens; Geldner, Götz; Roewer, Norbert

doi:10.1007/s00101-002-0373-y

Cited by 33 publications

(8 citation statements)

References 46 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Für Tropisetron gilt Ähnliches wie für Ondansetron; auch hier waren die initial verwendeten Dosierungen mit vornehmlich 5 mg höher. Nach aktueller Datenlage scheint eine Dosierung von 2 mg ausreichend [45]. Für Granisetron empfehlen die Mitglieder der Expertenkonferenz eine Dosierung von 1 mg [44,75].…”

Section: Propofolgabe Bei Total Intravenöser Anästhesieunclassified

Übelkeit und Erbrechen in der postoperativen Phase

et al. 2007

Self Cite

View full text Add to dashboard Cite

There are no consensus guidelines for the management of postoperative nausea and vomiting (PONV) in German speaking countries. This meeting was intended to develop such guidelines on which individual health care facilities can derive their specific standard operating procedures (SOPs). Anesthesiologists reviewed published literature on key topics which were subsequently discussed during two meetings. It was emphasized that recommendations were based on the best available evidence. The clinical relevance of individual risk factors should be viewed with caution since even well proven risk factors, such as the history of PONV, do not allow the identification of patients at risk for PONV with a satisfactory sensitivity or specificity. A more useful approach is the use of simplified risk scores which consider the presence of several risk factors simultaneously. Most individual antiemetic interventions for the prevention of PONV have comparable efficacy with a relative risk reduction of about 30%. This appears to be true for total intravenous anesthesia (TIVA) as well as for dexamethasone and other antiemetics; assuming a sufficiently high, adequate and equipotent dosage which should be weight-adjusted in children. As the relative risk reduction is context independent and similar between the interventions, the absolute risk reduction of prophylactic interventions is mainly dependent on the patient's individual baseline risk. Prophylaxis is thus rarely warranted in patients at low risk, generally needed in patients with a moderate risk and should include a multimodal approach in patients at high risk for PONV. Therapeutic interventions of PONV should be administered promptly using an antiemetic which has not been used before. The group suggests algorithms where prophylactic interventions are mainly dependent on the patient's risk for PONV. These algorithms should provide evidence-based guidelines allowing the development of SOPs/policies which take local circumstances into account.

show abstract

Section: Propofolgabe Bei Total Intravenöser Anästhesieunclassified

Übelkeit und Erbrechen in der postoperativen Phase

et al. 2007

Self Cite

View full text Add to dashboard Cite

show abstract

“…Both drugs have been tested in several randomized clinical trials and quantitative systematic reviews have proven their anti-emetic effectiveness [7][8][9]. Tropisetron, a highly selective antagonist at the serotonin-3 receptor (5-HT 3 -receptor antagonist) with an extended half-life of approximately 8 h, is available as a 5-mg tablet.…”

Section: Introductionmentioning

confidence: 99%

Anti‐emetic prophylaxis with oral tropisetron and/or dexamethasone

Eberhart

Büning

Folz

et al. 2006

Eur J Clin Investigation

Self Cite

View full text Add to dashboard Cite

Oral tropisetron and dexamethasone were both equally effective in reducing the severity and incidence of post-operative nausea and vomiting. The latter could be reduced by approximately 35% in a population of moderate-high risk for PONV. Both drugs had an additive effect. However, even in the combination group there still remained an unacceptably high incidence of PONV of more than 20%. This highlighted the need for a multimodal anti-emetic approach in high-risk patients and the importance of treatment of PONV.

show abstract

“…For example, even very effective anti-emetic drugs, such as a 5-HT 3 antagonist [10] or droperidol [11,12], cannot even halve the incidence of PONV. However, only a few studies have made use of this multimodal anti-emetic method [13,14].…”

Section: Discussionmentioning

confidence: 99%

“…Each intervention alone has been shown to significantly reduce the incidence of PONV. Administration of tropisetron [10] and dexamethasone [15,16], intravenous anaesthesia with propofol [17], and omission of nitrous oxide [9] are effective anti-emetic techniques on the highest level of evidencebased medicine (proven by quantitative systematic reviews). Initially, the study was designed with droperidol, the anti-emetic efficacy of which had also been demonstrated in two quantitative systematic reviews [11,12].…”

Section: Discussionmentioning

confidence: 99%

Impact of a multimodal anti‐emetic prophylaxis on patient satisfaction in high‐risk patients for postoperative nausea and vomiting

et al. 2002

Self Cite

View full text Add to dashboard Cite

Postoperative nausea and vomiting (PONV) are frequent and unpleasant symptoms. This prospective study aimed to assess the efficacy of a multimodal approach to prevent PONV, and patient satisfaction using the willingness-to-pay method. Two validated risk scores were applied to forecast the individual risk for PONV in 900 consecutive patients of whom 108 were identified as high-risk patients (predicted risk: 79-87%). High-risk patients received multimodal anti-emetic prophylaxis: total intravenous anaesthesia with propofol, high fractional inspired oxygen (80%), omission of nitrous oxide, dexamethasone 8 mg, haloperidol 10 lg.kg, and tropisetron 2 mg. Of the remaining patients with low or moderate risk for PONV, a random sample of 71 females received balanced propofol-desflurane anaesthesia without prophylactic anti-emetics. All patients were interviewed 2 and 24 h after surgery for occurrence of nausea and vomiting. Patient satisfaction was measured using the willingness-to-pay method. The incidence of PONV (95%-confidence interval) in the control-group was 41% (29-51%), slightly lower than predicted by the risk scores (53-57%). The multimodal anti-emetic approach reduced the predicted risk (79-87%) in the high risk-group to 7% (3-14%). This was associated with a high willingness-to-pay median (25th ⁄ 75th percentile) of £84 (£33-184) in the multimodal anti-emetic grouped compared to £14 (£4-30) in the control group. A multimodal anti-emetic approach can considerably reduce the incidence of PONV in high-risk patients and is associated with a high patient satisfaction as measured by the willingness-to-pay method.

show abstract

Tropisetron zur Prophylaxe von Übelkeit und Erbrechen in der postoperativen Phase

Abstract: Tropisetron significantly reduced the incidence of PONV. There is no clear evidence for a dose response between 2 and 5 mg iv. For children a dose of 0.1 mgxkg(-1) of body weight is effective. Sufficient data for the oral application of tropisetron are lacking.

Cited by 33 publications

References 46 publications

Übelkeit und Erbrechen in der postoperativen Phase

Übelkeit und Erbrechen in der postoperativen Phase

Anti‐emetic prophylaxis with oral tropisetron and/or dexamethasone

Impact of a multimodal anti‐emetic prophylaxis on patient satisfaction in high‐risk patients for postoperative nausea and vomiting

Contact Info

Product

Resources

About