Abstract
Purpose
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.
Methods
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.
Results
Data from 159 subjects were analyzed with 44 patients classified as low-risk and 115 patients classified as high-risk. Nine low-risk and 58 high-risk patients experienced PONV. The expected institutional PONV. incidence of 47% was reduced to 36%. Treatment with ondansetron was necessary in seven low-risk and 37 high-risk patients with a complete response rate of 71% (lowrisk) and 43% (high-risk).
Conclusion
Providing antiemetic prophylaxis with ondansetron to high-risk patients strictly based on a simplified risk score can reduce the overall institutional rate of PONV. However, classifying patients into two groups while using ondansetron as the single antiemetic in the high-risk group appears to be of limited efficacy as the incidence of PONV in high-risk patients is still double that of low-risk patients.
Résumé
Objectif
Le traitement antiémétique préventif courant des opérés semble justifié seulement en cas de risque accru de nausées et de vomissements postopératoires (NVPO). Nous voulions évaiuer la faisabilité et l’efficacité d’un traitement, adapté aux scores de risque dichotomique de NVPO, fondé sur une action préventive et thérapeutique avec l’ondansétron en regard du taux global de NVPO à l’hôpital.
Méthode
Après avoir estimé le potentiel individuel de NVPO par un score simplifié, 162 adultes devant subir une intervention chirurgicale réglée ont reçu soit 4 mg d’ondansétron par voie intraveineuse (de deux à quatre facteurs de risque = haut risque) ou aucune prophylaxie (zéro ou un facteur de risque = faible risque). Comme antiémétique, l’ondansétron a été administré par voie intraveineuse et orale. L’incidence des NVPO a été notée pendant les 24 premières heures après la récupération.
Résultats
Les données de 159 sujets ont été analysées dont celles de 44 patients à faible risque et 115 à haut risque. Neuf patients à faible risque et 58 à haut risque ont eu des NVPO. L’incidence attendue de NVPO de 47 % a été réduite à 36 %. Le traitement avec l’ondansétron a été nécessaire chez sept patients à faible risque et 37 à haut risque pour un taux de réponse complet de 71 % (faible risque) et 43 % (haut risque).
Conclusion
L’administration préventive d’antiémétique avec ondansétron aux patients à haut risque, fondée strictement sur un score de risque simplifié, peut réduire le taux global de NVPO à l’hôpital. Mais la répartition des patients en deux groupes et l’utilisation d’ondansétron antiémétique chez les patients à haut risque seulement nous semble d’efficacité limitée, étant donné que l’incidence de NVPO chez ces patients demeure deux fois plus élevée que chez les patients à faible risque.
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This study was supported by GlaxoSmithKline, Germany.
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Biedler, A., Wermelt, J., Kunitz, O. et al. A risk adapted approach reduces the overall institutional incidence of postoperative nausea and vomiting. Can J Anesth 51, 13–19 (2004). https://doi.org/10.1007/BF03018540
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DOI: https://doi.org/10.1007/BF03018540