Antiemetic Prophylaxis Does Not Improve Outcomes after Outpatient Surgery When Compared to Symptomatic Treatment

Scuderi, Phillip E.; James, Robert L.; Harris, Lynnette; Mims, Grover R.

doi:10.1097/00000542-199902000-00006

Cited by 140 publications

(79 citation statements)

References 17 publications

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“…This finding is supported by other authors 16 . Discussion is still on-going about whether intervention for PONV should take place preoperatively or if symptoms should be treated 17 . Systematic reviews suggest that prophylaxis is not always successful.…”

Section: Discussionmentioning

confidence: 99%

Incidence of Postoperative Nausea and Vomiting in Patients at a University Hospital. Where Are We Today?

Doubravská¹,

Dostalova²,

Fritscherova³

et al. 2010

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Aim.To determine the incidence of postoperative nausea and vomiting (PONV), identify risk factors, assess treatment and its effectiveness.Design. A prospective, observational, questionnaire-and interview-based study. Setting. Standard and intensive care units of the following university hospital departments: abdominal, thoracic and vascular surgery; gynecology; plastic and esthetic surgery; urology; and traumatology.Material and methods. Adult patients scheduled for elective surgery who gave informed consent were enrolled. A questionnaire-based study was performed on the first postoperative day. The collected data relevant to PONV were statistically analyzed.Conclusion. The incidence of PONV was significantly lower than generally presumed and was related to the patient gender, type of surgery and overall health status. PONV was more frequent in obese patients and when drugs antagonizing opioids or muscle relaxants were used. Early administration of antiemetic agents led to considerably less discomfort.

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Section: Discussionmentioning

confidence: 99%

Incidence of Postoperative Nausea and Vomiting in Patients at a University Hospital. Where Are We Today?

Doubravská¹,

Dostalova²,

Fritscherova³

et al. 2010

BIOMED PAP

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“…In patients who develop PONV despite receiving prophylaxis, an antiemetic acting at a different receptor should be used for rescue within the first six hours following surgery. 144 After six hours, PONV can be treated with any of the drugs used for prophylaxis except dexamethasone and scopolamine.…”

Section: Combination Antiemetic Therapy and Multimodal Approachmentioning

confidence: 99%

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

Habib

Gan

2004

Can J Anesth/J Can Anesth

195

106

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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

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“…No major benefit for routine antiemetic prophylaxis has been shown when drugs are administered non-selectively. 6 Such results are not without contradiction and Sadhasivam et al 9,10 reported that routine prophylaxis with ondansetron not only decreased the incidence and frequency of PONV but also led to greater patient satisfaction. The main reason for these inconsistencies may be related to differences in the underlying patient risk for PONV.…”

Section: Prophylaxis or Treatment Of Ponv?mentioning

confidence: 99%

“…A clinically significant improvement in patient satisfaction with prophylaxis seems to occur mainly in subgroups of patients at a high risk for PONV. 6,11 Therefore, a cost-effective approach to the management of PONV would be to provide prophylactic antiemetic therapy in situations with a high-risk of emesis and to give treatment for established PONV in situations where the risk is lower. In order to make such decisions for PONV management, it is mandatory to know the incidence of PONV in the local setting (e.g., by using an established risk score to assess the risk for PONV).…”

Section: Prophylaxis or Treatment Of Ponv?mentioning

confidence: 99%

“…5 Moreover, prophylactic compared with therapeutic antiemetic treatment improves the satisfaction of patients at increased risk for PONV but not the satisfaction of low-risk patients. 6 Considering this limited efficacy, routine antiemetic prophylaxis in unselected patients is questionable. Therefore, it appears more reasonable to manage PONV according to the individual risk of each patient.…”

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confidence: 99%

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Une approche préventive adaptée aux risques réduit l’incidence générale de nausées et de vomissements postopératoires en milieu hospitalier

Biedler

Wermelt

Kunitz

et al. 2004

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : Routine prophylactic antiemetic treatment of surgical patients appears justified only in case of an increased risk of postoperative nausea and vomiting (PONV). The objective of this investigation was to assess the feasibility and efficacy of a dichotomized risk score adapted management of PONV based on ondansetron prophylaxis and treatment with respect to the overall institutional rate of PONV. M Me et th ho od ds s: :After estimating the individual PONV risk by a simplified score, 162 adult patients scheduled for elective surgery received either 4 mg ondansetron intravenously (two to four risk factors = high-risk) or no prophylaxis (zero to one risk factor = low-risk). For antiemetic treatment ondansetron was given intravenously and orally. Incidence of PONV was recorded during the first 24 hr after recovery.

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Antiemetic Prophylaxis Does Not Improve Outcomes after Outpatient Surgery When Compared to Symptomatic Treatment

Abstract: Although PONV is unpleasant, the data indicate little difference in outcomes when routine prophylactic medications are administered versus simply treating PONV should symptoms occur.

Cited by 140 publications

References 17 publications

Incidence of Postoperative Nausea and Vomiting in Patients at a University Hospital. Where Are We Today?

Incidence of Postoperative Nausea and Vomiting in Patients at a University Hospital. Where Are We Today?

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

Une approche préventive adaptée aux risques réduit l’incidence générale de nausées et de vomissements postopératoires en milieu hospitalier

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