Combination of Antiemetics for the Prevention of PostoperativeNausea and Vomiting in High-Risk Patients

다국어 초록 (Multilingual Abstract)

It was previously reported that the Korean predictive model could be used to identify patients at high risk of postoperative nausea and vomiting (PONV). This study investigated whether PONV in the high-risk and very high-risk patients identified by the Korean predictive model could be prevented by multiple prophylactic antiemetics.

A total of 2,456 patients were selected from our previous PONV study and assigned to the control group, and 374 new patients were recruited consecutively to the treatment group. Patients in each group were subdivided into two risk groups according to the Korean predictive model: high-risk group and very high-risk group.

Patients in the treatment group received an antiemetic combination of dexamethasone 5 mg (minutes after induction) and ondansetron 4 mg (30 min before the end of surgery). The incidences of PONV were examined at two hours after the surgery in the postanesthetic care unit and, additionally, at 24 hr after the surgery in the ward, and were analyzed for any differences between the control and treatment groups. The overall incidence of PONV decreased significantly from 52.1% to 23.0% (p≤0.001) after antiemetic prophylaxis. Specifically, the incidence decreased from 47.3% to 19.4% (p≤0.001) in the high-risk group and from 61.3% to 28.3% (p≤0.001) in the very high-risk group. Both groups showed a similar degree of relative risk reductions: 59.0% vs. 53.8% in the high-risk and very high-risk groups, respectively. The results of our study showed that the antiemetic prophylaxis with the combination of dexamethasone and ondansetron was effective in reducing the occurrence of PONV in both high-risk and very high-risk patients.

참고문헌 (Reference)

1 "Watcha M. Consensus guidelines for managing postoperative naConsensus guidelines for managing postoperative nausea and vomitingusea and vomiting. Anesth Analg 2003" 97 : 62-71, 2003

2 "The cost-effective management of postoperative nauseaand vomiting" 92 : 931-933, 2000

3 "Strategies for postoperative nausea and vomiting" 18 : 693-701, 2004

4 "Risk factors for postoperative nausea and vomiting" 102 : 1884-1898, 2006

5 "Postoperative nausea and vomiting: prophy-laxis versus treatment" 89 : 1337-1339, 1999

6 "Food and drug administration black box warningon the perioperative use of droperidol: a review of the cases" 96 : 1377-1379, 2003

7 "Droperidol and5-HT3-receptor antagonists, alone or in combination, for prophylaxisof postoperative nausea and vomiting. A meta-analysis of randomised882 E.J. Kim, J.S. Ko, C.S. Kim, et al.controlled trials" 44 : 1252-1257, 2000

8 "Dexamethasone for the prevention ofpostoperative nausea and vomiting: a quantitative systematic review" 90 : 186-194, 2000

9 "Cost-effectiveness of prophylactic antiemetic therapywith ondansetron, droperidol, or placebo" 92 : 958-967, 2000

10 "Comparison of predictive models for postoperative nausea and vomiting" 88 : 234-240, 2002

11 "Comparativeefficacy and safety of ondansetron, droperidol, and metoclopramidefor preventing postoperative nausea and vomiting: a meta-analysis" 88 : 1370-1379, 1999

12 "Combination therapy for postoperative nauseaand vomiting - a more effective prophylaxis?" 9 : 59-71, 2001

13 "A survey of postoper-ative nausea and vomiting" 52 : 443-449, 1997

14 "A simpli-fied risk score for predicting postoperative nausea and vomiting:conclusions from cross-validations between two centers" 91 : 693-700, 1999

15 "A risk adapted approach reduces the overall institutionalincidence of postoperative nausea and vomiting" 51 : 13-19, 2004

16 "A randomized comparison of a multimodal management strategy versus combination antiemetics for the prevention of postoperative nausea and vomiting" 99 : 77-81, 2004

17 "A korean predictive model forpostoperative nausea and vomiting" 20 : 811-815, 2005

18 "A factorial trial of six interventions for theprevention of postoperative nausea and vomiting" 350 : 2441-2451, 2004