A Comparison of the Efficacy, Safety, and Patient Satisfaction of Ondansetron Versus Droperidol as Antiemetics for Elective Outpatient Surgical Procedures

Fortney, Jennifer T.; Gan, Tong J.; Graczyk, Sarena G.; Wetchler, Bernard V.; Melson, Timothy; Khalil, Sara; McKenzie, Ray; Parrillo, Stephen; Glass, Peter S. A.; Moote, Carol A.; Wermeling, Daniel P.; Parasuraman, T.V.; Duncan, Benjamin; Creed, Mary R.

doi:10.1097/00000539-199804000-00011

Cited by 90 publications

(55 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Similar results have also been found by Fortney et al 17 and Tang et al 16 There was also a lack of difference in adverse effects (e.g. shivering, headache, dizziness probably due to the general anesthetic agents) among the four study groups except that the group receiving 1.25 mg droperidol alone experienced more severe drowsiness (which may have delayed discharge) as is expected for droperidol.…”

Section: Discussionsupporting

confidence: 85%

Additive anti-emetic efficacy of prophylactic ondansetron with droperidol in out-patient gynecological laparoscopy

Belo

Koutsoukos

2000

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

Purpose: To determine the efficacy of ondansetron and droperidol, alone and in combination, administered for prophylaxis of postoperative nausea and vomiting (PONV) in women undergoing general anesthesia for outpatient gynecological laparoscopy.Methods: Following Institutional Ethics Board approval and patient consent, 160 female out-patients scheduled for laparoscopy were randomly allotted in a double-blind fashion to receive: i) saline (placebo), ii) 4 mg ondansetron, iii) 1.25 mg droperidol, or iv) 4 mg ondansetron and 1.25 mg droperidol combination intravenously on induction. Following a standardized general anesthesia, patients were interviewed and assessed for PONV at various times.Results: During the first 24 hr after surgery, the incidence of PONV in the placebo group was 71%. This was reduced to 61% with droperidol alone (P = 0.334), to 46% with ondansetron alone (P = 0.027), and to 23% with the combination group (P < 0.001). A statistically significant difference was observed between combination and droperidol (P < 0.001) and between combination and ondansetron (P = 0.036). There were fewer requests for rescue medication from the combination group (7.7%) than from the ondansetron and placebo groups. Conclusion:The results of this study suggest that the combination of 4 mg ondansetron and 1.25 mg droperidol is more efficacious as a prophylactic anti-emetic than either agent alone during the 24 hr post-surgery. This additive effect may be due to the different mechanisms of action of ondansetron and droperidol.Objectif : Déterminer l'efficacité de l'ondansétron et du dropéridol, seuls ou combinés, administrés comme prophylaxie des nausées et vomissements postopératoires (NVPO) chez des patientes sous anesthésie générale lors d'une laparoscopie gynécologique en clinique externe.Méthode : Après avoir obtenu l'autorisation du Comité d'éthique médicale et le consentement des patientes, on a procédé à l'étude de 160 femmes, réparties au hasard en double aveugle, qui ont reçu avant la laparoscopie ambulatoire prévue : i) une solution salée (placebo), ii) 4 mg d'ondansétron, iii) 1,25 mg de dropéridol, ou iv) une combinaison intraveineuse de 4 mg d'ondansétron et de 1,25 mg de dropéridol à l'induction de l'anesthésie. Après l'anesthésie générale standard, les patientes ont été interrogées sur les NVPO à différents temps.Résultats : Pendant les 24 premières heures postopératoires, l'incidence des NVPO ont été de 71 % dans le groupe placebo. Cette incidence a été réduite à 61% avec de dropéridol employé seul (P = 0,334), à 46 % avec l'ondansétron seul (P = 0,027) et à 23 % avec la combinaison des deux médicaments (P < 0,001). Une différence statistiquement différente a été observée entre la combinaison et le dropéridol (P < 0,001) et entre la combinaison et l'ondansétron (P = 0,036). On enregistre moins de demandes de médication de rattrapage provenant des patientes qui ont reçu la combinaison de médicaments (7,7 %) que de celles qui ont reçu l'ondansétron ou le placebo.Conclusion : Les résultats de l'étude suggèr...

show abstract

Section: Discussionsupporting

confidence: 85%

Additive anti-emetic efficacy of prophylactic ondansetron with droperidol in out-patient gynecological laparoscopy

Belo

Koutsoukos

2000

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

show abstract

“…Low doses of droperidol (0.625-1.25 mg) were not associated with any increased sedation compared to ondansetron 4 mg (IA). 62 In December 2001, the Food and Drug Administration (FDA) issued a new 'black box' warning on droperidol, which is the most serious warning for a FDA-approved drug. The FDA noted that its use has been associated with QTc segment prolongation and/or torsades de pointes, and in some cases resulted in fatal cardiac arrhythmias.…”

Section: Older Generation Antiemeticsmentioning

confidence: 99%

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

Habib

Gan

2004

Can J Anesth/J Can Anesth

Self Cite

196

106

View full text Add to dashboard Cite

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

show abstract

“…Studies show that there is no statistical difference in prophylaxis of PONV and occurrence of para-effects with droperidol (0.625mg or 1.25 mg) or ondansetron (4 mg). (34) In 2001, the Food and Drug Administration (FDA) ruled that droperidol should be restricted to patients who did not respond to or tolerate other treatments. |Due to the risk of triggering a prolonged QT interval and arrhythmias, patients must be submitted to cardiac monitoring before and after use of this drug.…”

Section: Preoperative Strategiesmentioning

confidence: 99%