Ondansetron is no More Effective than Supplemental Intraoperative Oxygen for Prevention of Postoperative Nausea and Vomiting

Goll, V.; Akça, Ozan; Greif, Robert; Freitag, Helma; Arkiliç, Cem F.; Scheck, Thomas; Zoeggeler, Agnes; Kurz, Andrea; Krieger, G.; Lenhardt, Rainer; Sessler, Daniel I.

doi:10.1097/00000539-200101000-00022

Cited by 152 publications

(133 citation statements)

References 21 publications

Supporting

Mentioning

122

Contrasting

Unclassified

Order By: Relevance

“…102 In two studies by one group, oxygen supplementation (80%) intraoperatively or both intraoperatively and for two hours postoperatively was effective in achieving a significant reduction in the incidence of PONV compared to patients receiving 30% oxygen (IIIB). 103,104 These findings were not confirmed in a more recent study in females undergoing ambulatory gynecologic surgery. In this study, 80% oxygen was given intraoperatively and for up to one hour postoperatively.…”

Section: Other Interventions With Potential Antiemetic Effectscontrasting

confidence: 66%

“…2,[8][9][10][11][12][13] The use of large doses of neostigmine (> 2.5 mg) increases the risk of PONV. 14 Other strategies that might reduce the incidence of PONV include the use of supplemental intraoperative oxygen (FIO 2 = 0.8), 103,104 adequate hydration especially using colloids, 106,107 anxiolysis with benzodiazepines, 122 and the use of α 2 -agonists. 101,102 Scuderi et al tested a multimodal approach to the management of PONV in females undergoing outpatient laparoscopy.…”

Section: Combination Antiemetic Therapy and Multimodal Approachmentioning

confidence: 99%

See 1 more Smart Citation

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

Habib

Gan

2004

Can J Anesth/J Can Anesth

195

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

Section: Other Interventions With Potential Antiemetic Effectscontrasting

confidence: 66%

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

View full text Add to dashboard Cite

show abstract

“…The latter advantage has been negated by PONV, which is turning out to be the leading cause of unexpected re-admission after day surgery. 13,14 The incidence of PONV has been reported to be as high as 53-72%. 15 After laparoscopic cholecystectomy up to 70% patients have PONV if they are not on any antiemetic prophylaxis.…”

Section: Me Et Th Ho Od Ds S Following Approval From Our Institutiomentioning

confidence: 99%

Acupressure and ondansetron for postoperative nausea and vomiting after laparoscopic cholecystectomy

Agarwal

Bose

Gaur

et al. 2002

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

P Pu ur rp po os se e: : To compare the efficacy of acupressure wrist bands and ondansetron for the prevention of postoperative nausea and vomiting (PONV).M Me et th ho od ds s: : One hundred and fifty ASA I-II, patients undergoing elective laparoscopic cholecystectomy were included in a randomized, prospective, double-blind and placebo-controlled study. Patients were divided into three groups of 50. Group I was the control; Group II received ondansetron 4 mg iv just prior to induction of anesthesia; in Group III acupressure wristbands were applied at the P6 points. Acupressure wrist bands were placed inappropriately in Groups I and II. The acupressure wrist bands were applied 30 min prior to induction of anesthesia and removed six hours following surgery. Anesthesia was standardized. PONV were evaluated separately as none, mild, moderate or severe within six hours of patients' arrival in the postanesthesia care unit and then at 24 hr after surgery by a blinded observer. If patients vomited more than once, they were given 4 mg ondansetron iv as the rescue antiemetic. Results were analyzed by Z test. A P value of < 0.05 was taken as significant. R Re es su ul lt ts s: : The incidence of PONV and the requirement of rescue medication were significantly lower in both the acupressure and ondansetron groups during the first six hours.C Co on nc cl lu us si io on n: : Acupressure at P6 causes a significant reduction in the incidence of PONV and the requirement for rescue medication in the first six hours following laparoscopic cholecystectomy, similar to that of ondansetron 4 mg iv. Objectif : Comparer l'efficacité des bandes d'acupression et de l'ondansétron comme prévention des nausées et vomissements postopératoires (NVPO). Méthode : Cent cinquante patients d'état physique ASA I-II devant subir une cholécystectomie laparoscopique ont été recrutés pour une étude prospective, randomisée et à double insu contre placebo. Ils ont été répartis en trois groupes de 50. Le groupe I a été le groupe témoin; les patients du groupe II ont reçu 4 mg iv d'ondansétron juste avant l'induction de l'anesthésie; chez les patients du groupe III, on a appliqué des bandes d'acupression aux point P6. Des bandes d'acupression ont été placées de façon inappropriée chez les patients des groupes I et II. Les bandes ont été appliquées 30 min avant l'induction

show abstract

“…Relatos entre a associação de concentrações elevadas de oxigênio inspirado e colapso pulmonar têm sido descritos há pelo menos 50 anos 8 . Apesar de os efeitos benéficos serem atribuídos ao uso da concentração alta de oxigênio durante a anestesia, como a redução de náusea e vômito pós-operatório 37 , ao aumento das respostas pró-inflamató-rias e atividade antimicrobiana dos macrófagos alveolares 38 , à possível diminuição na infecção da ferida cirúrgica no pós-operatório 39 e à prevenção de episódios de hipoxemia, as atelectasias desenvolvidas no período intra-operatório não são prontamente revertidas no pós-operatório e podem persistir por vários dias, aumentando o tempo de ventilação mecânica, a necessidade de fisioterapia respiratória, a duração da internação hospitalar e os custos. Avaliando cautelosamente esses dados, evidências atuais não sugerem que possíveis benefícios do uso de altas concentrações de oxigênio possam contrabalançar as conseqüências deleté-rias de complicações pulmonares pós-operatórias.…”

Section: Mecanismos Do Colapso Pulmonar Intra-operatóriounclassified

“…There have been reports in the literature associating high inspired fractions of oxygen and pulmonary collapse for at least fifty years 8 . Although some benefits have been attributed to the use of high oxygen concentrations during anesthesia, such as reduction in postoperative nausea and vomiting 37 , increase in pro-inflammatory responses and antimicrobiotic activity of alveolar macrophages 38 , possible reduction in postoperative infection of the surgical wound 39 and prevention of episodes of hypoxemia, postoperative atelectasis do not reverse immediately and might persist for several days increasing the time of mechanical ventilation required, the need of respiratory therapy, increased length of hospita-lization and health care costs. Weighing those data carefully, current evidence does not indicate that the possible benefits of the use of high oxygen concentrations can overcome the detrimental consequences of postoperative pulmonary complications.…”

Section: Mechanisms Of Intraoperative Pulmonary Collapsementioning

confidence: 99%

Atelectasias durante anestesia: fisiopatologia e tratamento

Malbouisson¹,

Humberto²,

Rodrigues³

et al. 2008

Rev. Bras. Anestesiol.

View full text Add to dashboard Cite

Rev Bras AnestesiolARTIGO DE REVISÃO 2008; 58: 1: 73-83 REVIEW ARTICLE RESUMOMalbouisson LMS, Humberto F, Rodrigues RR, Carmona MJC, Auler Jr JOC -Atelectasias durante Anestesia: Fisiopatologia e Tratamento. JUSTIFICATIVA E OBJETIVOS:O colapso pulmonar intra-operatório é uma complicação de elevada incidência em pacientes submetidos à intervenção cirúrgica sob anestesia geral com relaxamento/paralisia da musculatura. Essa complicação está associada à piora das trocas gasosas no intra-operatório e, em alguns casos, necessidade de suporte respiratório prolongado no perío-do pós-operatório. Os objetivos deste estudo foram revisar os aspectos fisiopatológicos da formação de atelectasias durante anestesia geral e as possíveis manobras terapêuticas para prevenir e tratar essa complicação.CONTEÚDO: Nesta revisão, os conceitos sobre a incidência de atelectasias intra-operatórias, os fatores relacionados com o seu desenvolvimento, tanto mecânicos quanto associados ao ajuste do respirador durante procedimento cirúrgico, os aspectos do diagnós-tico e as estratégias de prevenção e tratamento foram abordados de maneira sistemática. CONCLUSÕES:A compreensão dos mecanismos relacionados com o desenvolvimento do colapso pulmonar durante o período intra-operatório, assim como o seu tratamento, pode contribuir para a redução da incidência de complicações pulmonares pós-operatórias, o tempo de recuperação e os custos hospitalares.Unitermos: COMPLICAÇÕES: atelectasia; colapso pulmonar; VEN-TILAÇÃO: controlada mecânica, manobra de recrutamento alveolar, pressão positiva ao final da expiração. SUMMARYMalbouisson LMS, Humberto F, Rodrigues RR, Carmona MJC, Auler Jr JOC -Atelectasis During Anesthesia: Pathophysiology and Treatment. BACKGROUND AND METHODS:The incidence of intraoperative pulmonary collapse is elevated in patients undergoing surgery under general anesthesia with muscle relaxation/paralysis. This complication is associated with worsening intraoperative gas exchange and, in some cases, the need for prolonged postoperative respiratory support. The objective of this report was to review the pathophysiological aspects of atelectasis during general anesthesia and possible therapeutic maneuvers that could prevent and treat this complication. CONTENTS:This review discusses the concepts about the incidence of intraoperative atelectasis, factors that influence their development, both mechanical and those related to mechanical ventilator settings during the surgery, diagnostic criteria, and strategies to prevent and treat this complication. CONCLUSIONS:Understanding of the mechanisms related with the development of intraoperative pulmonary collapse, as well as its treatment, can contribute to reduce the incidence of postoperative pulmonary complications, the length of recovery and hospital costs.

show abstract

Ondansetron is no More Effective than Supplemental Intraoperative Oxygen for Prevention of Postoperative Nausea and Vomiting

Abstract: Supplemental oxygen reduces the risk of postoperative nausea and vomiting (PONV) as well or better than 8 mg of ondansetron. Because oxygen is inexpensive and essentially risk-free, supplemental oxygen is a preferable method of reducing PONV.

Cited by 152 publications

References 21 publications

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

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

Acupressure and ondansetron for postoperative nausea and vomiting after laparoscopic cholecystectomy

Atelectasias durante anestesia: fisiopatologia e tratamento

Contact Info

Product

Resources

About