Comparison of the antiemetic effect of ramosetron with ondansetron in patients undergoing microvascular decompression with retromastoid craniotomy: a preliminary report

다국어 초록 (Multilingual Abstract)

Background: Microvascular decompression with retromastoid craniotomy carries an especially high risk of postoperative nausea and vomiting. In this study, we compare the antiemetic efficacy of ramosetron and ondansetron in patients undergoing microvascular decompression with retromastoid craniotomy.
Methods: Using balanced anesthesia with sevoflurane and remifentanil infusion, ondansetron 8 mg (group O, n = 31) or ramosetron 0.3 mg (group R, n = 31) was administered at the dural closure. The incidence and severity of postoperative nausea and vomiting, required rescue medications and the incidence of side effects were measured at post-anesthetic care unit, 6, 24 and 48 hours postoperatively. Independent t-tests and the chi-square test or Fisher’s exact test were used for statistical analyses.
Results: There were no differences in the demographic data between groups, except for a slightly longer anesthetic duration of group R (P = 0.01). The overall postoperative 48 hour incidences of nausea and vomiting were 93.6 and 61.3% (group O), and 87.1 and 51.6% (group R), respectively. Patients in group R showed a less severe degree of nausea (P = 0.02) and a lower incidence of dizziness (P = 0.04) between 6 and 24 hours.
Conclusions: The preventive efficacy of ramosetron when used for postoperative nausea and vomiting was similar to that of ondansetron up to 48 hours after surgery in patients undergoing microvascular decompression with retromastoid craniotomy. A larger randomized controlled trial is needed to confirm our findings.

참고문헌 (Reference)

1 Neufeld SM, "The efficacy of 5-HT3 receptor antagonists for the prevention of postoperative nausea and vomiting after craniotomy : a meta-analysis" 19 : 10-17, 2007

2 Claybon L, "Single dose intravenous ondansetron for the 24-hour treatment of postoperative nausea and vomiting" 49 (49): 24-29, 1994

3 Rabasseda X., "Ramosetron, a 5-HT3 receptor antagonist for the control of nausea and vomiting" 38 : 75-89, 2002

4 Eberhart LH, "Prevention and control of postoperative nausea and vomiting in post-craniotomy patients" 21 : 575-593, 2007

5 Latz B, "Postoperative nausea and vomiting in patients after craniotomy : incidence and risk factors" 114 : 491-496, 2011

6 Andrews PL., "Physiology of nausea and vomiting" 69 (69): 2-19, 1992

7 Frost F, "Ondansetron : a meta-analysis on its efficacy to prevent postoperative nausea and vomiting after craniotomy in adults and children" 29 : 19-24, 2010

8 Gore PA, "Normobaric oxygen therapy strategies in the treatment of postcraniotomy pneumocephalus" 108 : 926-929, 2008

9 Seubert CN, "Miller’s Anesthesia. 7th ed" Livingstone Elsevier 1477-1514, 2010

10 Sato K, "Is microvascular decompression surgery a high risk for postoperative nausea and vomiting in patients undergoing craniotomy?" 27 : 725-730, 2013

11 Tan C, "Indication for surgery and the risk of postoperative nausea and vomiting after craniotomy : a case-control study" 24 : 325-330, 2012

12 Tramer MR, "Efficacy, dose-response, and safety of ondansetron in prevention of postoperative nausea and vomiting : a quantitative systematic review of randomized placebo-controlled trials" 87 : 1277-1289, 1997

13 Choi YS, "Effect of ramosetron on patient-controlled analgesia related nausea and vomiting after spine surgery in highly susceptible patients: comparison with ondansetron" 33 : 602-606, 2008

14 Hahm TS, "Comparison of the prophylactic anti-emetic efficacy of ramosetron and ondansetron in patients at high-risk for postoperative nausea and vomiting after total knee replacement" 65 : 500-504, 2010

15 Jae-Woo Lee, "Comparison of ramosetron’s and ondansetron’s preventive anti-emetic effects in highly susceptible patients undergoing abdominal hysterectomy" 대한마취통증의학회 61 (61): 488-492, 2011

16 Meng L, "Assessing risk factors for postoperative nausea and vomiting : a retrospective study in patients undergoing retromastoid craniectomy with microvascular decompression of cranial nerves" 18 : 235-239, 2006

17 Fabling JM, "A randomized, double-blind comparison of ondansetron versus placebo for prevention of nausea and vomiting after infratentorial craniotomy" 14 : 102-107, 2002

18 Habib AS, "A comparison of the combination of aprepitant and dexamethasone versus the combination of ondansetron and dexamethasone for the prevention of postoperative nausea and vomiting in patients undergoing craniotomy" 112 : 813-818, 2011