Klinische Pharmakologie

Abstract

The rule of three describes three steps which are needed for an optimal control of postoperative nausea and vomiting (PONV). Firstly, patients at high risk of PONV need to be identified. Knowledge about predictive factors may help to identify patients who may best profit from prophylaxis and those where prophylaxis is not worthwhile since the baseline risk is too low. Secondly, for high-risk patients a low emetogenic anaesthesia technique should be chosen, and thirdly, these patients should additionally receive a prophylactic antiemetic cocktail. At present, butyrophenones (e.g. droperidol), 5-HT(3) receptor antagonists ("setrons") and steroids (e.g. dexamethasone) are the most rational choices for the antiemetic cocktail. Although there is strong evidence that there is an additive effect when these antiemetics are combined, economic constraints may influence the number of antiemetics that are eventually chosen. Identification of high-risk patients remains the most difficult part of the rule of three. Risk scores have been proposed and have been widely implemented in clinical practice. The sensitivity and specificity of such scores, however, remain particularly unsatisfactory. Unless more reliable risk scores are developed, aggressive treatment of established PONV symptoms may be more useful and more cost-effective than prophylaxis for many patients.

Effects of preoperative administration of ginger (Zingiber officinale Roscoe) on postoperative nausea and vomiting after laparoscopic cholecystectomy

“… 1 , 2 , 3 , 4 , 5 , 6 Although some believe that the main causative factor for PONV is the anesthetic materials, several studies demonstrated effect of a wide range of factors such as age, sex, the time between last meal and operation, the history of PONV, the anesthetic methods and the type of surgical procedures on PONV. 2 , 4 , 5 Since long hospital stay, poor patient satisfaction from the medical team and increased treatment cost are the most morbidities associated with postoperative nausea and vomiting, its prevention and treatment pose a significant challenge in the modern medicine. 2 , 5 , 6 , 7 Other complications of PONV include electrolyte disorders, increased pain, hypertension and probably elevated risk of pulmonary aspiration.…”

“…2 , 5 , 6 , 7 Other complications of PONV include electrolyte disorders, increased pain, hypertension and probably elevated risk of pulmonary aspiration. 2 , 3 , 4 …”

“…Although several agents such as Metoclopramid, Droperidol, Dexamethasone and Diphenhydramine have been used for this purpose, and finally intravenous administration of ondansetron has been suggested as the standard medication, efforts in presenting a gold standard drug is still under progress. 4 , 8 , 9…”

Prophylaxis of intra- and postoperative nausea and vomiting in patients during cesarean section in spinal anesthesia

“…According to the investigations of Apfel and others, serotonin antagonists are primarily used as second- or third-line drugs in preventing or treating PONV [32,40]. The relative expensiveness of these drugs may limit general use, considering increasing economic constraints in most health care systems [40,41]. …”

Palonosetron Hydrochloride in the Prevention and Treatment of Postoperative Nausea and Vomiting

“…Patients at high risk for PONV should be provided with a combination prophylaxis and as many potential risk factors as possible should be eliminated, whereas patients with a low risk of PONV might be supported with one antiemetic or managed with a "wait-and-see" strategy. 26 This means that patients with a very low risk of PONV should not be exposed to the potential side effects of antiemetics and should only be treated with antiemetics if PONV really occurs.…”