Abstract
Purpose
To provide evidence-based guidelines for the prophylaxis and treatment of postoperative nausea and vomiting (PONV).
Source
Literature from randomized controlled trials, systematic reviews, logistic regression analyses and expert opinion in the management of PONV.
Principal findings
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.
Conclusion
PONV are common after anesthesia and surgery. We provided evidence-based guidelines for the management of this problem based on the available literature.
Résumé
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 une prévention mieux ciblée. Aucune prophylaxie n’est nécessaire en cas de risque faible. En cas de risque modéré, l’usage d’un seul antiémétique ou d’une combinaison de deux médicaments est une mesure préventive à envisager. On peut combiner deux ou trois antiémétiques en cas de risque élevé. De plus, une approche multimodale doit être adoptée et utilisée par étapes afin de conserver le risque de base faible. La méthode de traitement des NVPO la plus rentable sera différente selon qu’il s’agit d’un patient ambulatoire ou hospitalisé. Le traitement des NVPO établis chez des patients qui n’ont pas répondu au traitement préventif ne doit pas comporter une seconde dose de l’antiémétique prophylactique. Un médicament actif au niveau d’un autre récepteur sera privilégié. Au delà de six heures après l’opération, on peut traiter avec n’importe quel médicament utilisé comme prévention, sauf la dexaméthasone et la scopolamine transdermique.
Conclusion
Les NVPO sont fréquents après l’anesthésie et la chirurgie. Nous avons présenté des lignes de conduite à adopter fondées sur les données probantes de la documentation disponible.
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References
Cohen MM, Duncan PG, DeBoer DP, Tweed WA. The postoperative interview: assessing risk factors for nausea and vomiting. Anesth Analg 1994; 78: 7–16.
Apfel CC, Laara E, Koivuranta M, Greim CA, Roewer N. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Anesthesiology 1999; 91: 693–700.
Gold BS, Kitz DS, Lecky JH, Neuhaus JM. Unanticipated admission to the hospital following ambulatory surgery. JAMA 1989; 262: 3008–10.
Myles PS, Williams DL, Hendrata M, Anderson H, Weeks AM. Patient satisfaction after anaesthesia and surgery: results of a prospective survey of 10 811 patients. Br J Anaesth 2000; 84: 6–10.
Macario A, Weinger M, Carney S, Kim A. Which clinical anesthesia outcomes are important to avoid? The perspective of patients. Anesth Analg 1999; 89: 652–8.
Gan T, Sloan F, Dear Gde L, El-Moalem HE, Lubarsky DA. How much are patients willing to pay to avoid postoperative nausea and vomiting? Anesth Analg 2001; 92: 393–400.
Gan TJ, Meyer T, Apfel CC, et al. Consensus guidelines for managing postoperative nausea and vomiting. Anesth Analg 2003; 97: 62–71.
Apfel CC, Kranke P, Katz MH, et al. Volatile anaesthetics may be the main cause of early but not delayed postoperative vomiting: a randomized controlled trial of factorial design. Br J Anaesth 2002; 88: 659–68.
Tramer M, Moore A, McQuay H. Omitting nitrous oxide in general anaesthesia: meta-analysis of intraoperative awareness and postoperative emesis in randomized controlled trials. Br J Anaesth 1996; 76: 186–93.
Apfel CC, Kranke P, Eberhart LH, Roos A, Roewer N. Comparison of predictive models for postoperative nausea and vomiting. Br J Anaesth 2002; 88: 234–40.
Sukhani R, Vazquez J, Pappas AL, Frey K, Aasen M, Slogoff S. Recovery after propofol with and without intraoperative fentanyl in patients undergoing ambulatory gynecologic laparoscopy. Anesth Analg 1996; 83: 975–81.
Moiniche S, Romsing J, Dahl JB, Tramer MR. Nonsteroidal antiinflammatory drugs and the risk of operative site bleeding after tonsillectomy: a quantitative systematic review. Anesth Analg 2003; 96: 68–77.
Polati E, Verlato G, Finco G, et al. Ondansetron versus metoclopramide in the treatment of postoperative nausea and vomiting. Anesth Analg 1997; 85: 395–9.
Tramer MR, Fuchs-Buder T. Omitting antagonism of neuromuscular block: effect on postoperative nausea and vomiting and risk of residual paralysis. A systematic review. Br J Anaesth 1999; 82: 379–86.
Sinclair DR, Chung F, Mezei G. Can postoperative nausea and vomiting be predicted? Anesthesiology 1999; 91: 109–18.
Koivuranta M, Laara E, Snare L, Alahuhta S. A survey of postoperative nausea and vomiting. Anaesthesia 1997; 52: 443–9.
Fabling JM, Gan TJ, El-Moalem HE, Warner DS, Borel CO. A randomized, double-blinded comparison of ondansetron, droperidol, and placebo for prevention of postoperative nausea and vomiting after supratentorial craniotomy. Anesth Analg 2000; 91: 358–61.
Gan TJ, Ginsberg B, Grant AP, Glass PS. Doubleblind, randomized comparison of ondansetron and intraoperative propofol to prevent postoperative nausea and vomiting. Anesthesiology 1996; 85: 1036–42.
Beattie WS, Lindblad T, Buckley DN, Forrest JB. Menstruation increases the risk of nausea and vomiting after laparoscopy. A prospective randomized study. Anesthesiology 1993; 78: 272–6.
Honkavaara P, Lehtinen AM, Hovorka J, Korttila K. Nausea and vomiting after gynaecological laparoscopy depends upon the phase of the menstrual cycle. Can J Anaesth 1991; 38: 876–9.
Gratz I, Allen E, Afshar M, Joslyn AF, Buxbaum J, Prilliman B. The effects of the menstrual cycle on the incidence of emesis and efficacy of ondansetron. Anesth Analg 1996; 83: 565–9.
Eberhart LH, Morin AM, Georgieff M. The menstruation cycle in the postoperative phase. Its effect of the incidence of nausea and vomiting (German). Anaesthesist 2000; 49: 532–5.
Kranke P, Apfel CC, Papenfuss T, et al. An increased body mass index is no risk factor for postoperative nausea and vomiting. A systematic review and results of original data. Acta Anaesthesiol Scand 2001; 45: 160–6.
Stadler M, Bardiau F, Seidel L, Albert A, Boogaerts JG. Difference in risk factors for postoperative nausea and vomiting. Anesthesiology 2003; 98: 46–52.
Rose JB, Watcha MF. Postoperative nausea and vomiting in paediatric patients. Br J Anaesth 1999; 83: 104–17.
Cohen MM, Cameron CB, Duncan PG. Pediatric anesthesia morbidity and mortality in the perioperative period. Anesth Analg 1990; 70: 160–7.
Lerman J. Surgical and patient factors involved in postoperative nausea and vomiting. Br J Anaesth 1992; 69: 24S-32S.
Palazzo M, Evans R. Logistic regression analysis of fixed patient factors for postoperative sickness: a model for risk assessment. Br J Anaesth 1993; 70: 135–40.
Kranke P, Morin AM, Roewer N, Wulf H, Eberhart LH. The efficacy and safety of transdermal scopolamine for the prevention of postoperative nausea and vomiting: a quantitative systematic review. Anesth Analg 2002; 95: 133–43.
Kranke P, Morin AM, Roewer N, Eberhart LH. Dimenhydrinate for prophylaxis of postoperative nausea and vomiting: a meta-analysis of randomized controlled trials. Acta Anaesthesiol Scand 2002; 46: 238–44.
Henzi I, Sonderegger J, Tramer MR. Efficacy, doseresponse, and adverse effects of droperidol for prevention of postoperative nausea and vomiting. Can J Anesth 2000; 47: 537–51.
Tramer MR, Walder B. Efficacy and adverse effects of prophylactic antiemetics during patient-controlled analgesia therapy: a quantitative systematic review. Anesth Analg 1999; 88: 1354–61.
Tramer MR, Reynolds DJ, Moore RA, McQuay HJ. Efficacy, dose-response, and safety of ondansetron in prevention of postoperative nausea and vomiting: a quantitative systematic review of randomized placebocontrolled trials. Anesthesiology 1997; 87: 1277–89.
Kranke P, Eberhart LH, Apfel CC, Broschert J, Geldner G, Roewer N. Tropisetron for prevention of postoperative nausea and vomiting: a quantitative systematic review (German). Anaesthesist 2002; 51: 805–14.
Henzi I, Walder B, Tramer MR. Metoclopramide in the prevention of postoperative nausea and vomiting: a quantitative systematic review of randomized, placebo-controlled studies. Br J Anaesth 1999; 83: 761–71.
Tramer M, Moore A, McQuay H. Propofol anaesthesia and postoperative nausea and vomiting: quantitative systematic review of randomized controlled studies. Br J Anaesth 1997; 78: 247–55.
Henzi I, Walder B, Tramer MR. Dexamethasone for the prevention of postoperative nausea and vomiting: a quantitative systematic review. Anesth Analg 2000; 90: 186–94.
Lee A, Done ML. The use of nonpharmacologic techniques to prevent postoperative nausea and vomiting: a meta-analysis. Anesth Analg 1999; 88: 1362–9.
Sun R, Klein KW, White PF. The effect of timing of ondansetron administration in outpatients undergoing otolaryngologic surgery. Anesth Analg 1997; 84: 331–6.
Tang J, Wang B, White PF, Watcha MF, Qi J, Wender RH. The effect of timing of ondansetron administration on its efficacy, cost-effectiveness, and cost-benefit as a prophylactic antiemetic in the ambulatory setting. Anesth Analg 1998; 86: 274–82.
Tramer M, Moore A, McQuay H. Meta-analytic comparison of prophylactic antiemetic efficacy for postoperative nausea and vomiting: propofol anaesthesia vs omitting nitrous oxide vs total i.v. anaesthesia with propofol. Br J Anaesth 1997; 78: 256–9.
Graczyk SG, McKenzie R, Kallar S, et al. Intravenous dolasetron for the prevention of postoperative nausea and vomiting after outpatient laparoscopic gynecologic surgery. Anesth Analg 1997; 84: 325–30.
Chen X, Tang J, White PF, et al. The effect of timing of dolasetron administration on its efficacy as a prophylactic antiemetic in the ambulatory setting. Anesth Analg 2001; 93: 906–11.
Wilson AJ, Diemunsch P, Lindeque BG, et al. Singledose i.v. granisetron in the prevention of postoperative nausea and vomiting. Br J Anaesth 1996; 76: 515–8.
Mikawa K, Takao Y, Nishina K, Shiga M, Maekawa N, Obara H. Optimal dose of granisetron for prophylaxis against postoperative emesis after gynecological surgery. Anesth Analg 1997; 85: 652–6.
D’Angelo R, Minkowitz H, Dalby P, et al. A pilot, randomized, double-blind, dose-ranging study of intravenous granisetron (Kytril®) in the prevention of postoperative nausea and vomiting (PONV) in subjects undergoing abdominal hysterectomy. New York Society of Anesthesiologists Postgraduate Assembly 2002.
Taylor AM, Rosen M, Diemunsch PA, Thorin D, Houweling PL. A double-blind, parallel-group, placebo-controlled, dose-ranging, multicenter study of intravenous granisetron in the treatment of postoperative nausea and vomiting in patients undergoing surgery with general anesthesia. J Clin Anesth 1997; 9: 658–63.
Fujii Y, Saitoh Y, Tanaka H, Toyooka H. Ramosetron for preventing postoperative nausea and vomiting in women undergoing gynecological surgery. Anesth Analg 2000; 90: 472–5.
Naguib M, el Bakry AK, Khoshim MH, et al. Prophylactic antiemetic therapy with ondansetron, tropisetron, granisetron and metoclopramide in patients undergoing laparoscopic cholecystectomy: a randomized, double-blind comparison with placebo. Can J Anaesth 1996; 43: 226–31.
Zarate E, Watcha MF, White PF, Klein K, Rego MS, Stewart DG. A comparison of the costs and efficacy of ondansetron versus dolasetron for antiemetic prophylaxis. Anesth Analg 2000; 90: 1352–8.
Walker JB. Efficacy of single-dose intravenous dolasetron versus ondansetron in the prevention of postoperative nausea and vomiting. Clin Ther 2001; 23: 932–8.
Korttila K, Clergue F, Leeser J, et al. Intravenous dolasetron and ondansetron in prevention of postoperative nausea and vomiting: a multicenter, doubleblind, placebo-controlled study. Acta Anaesthesiol Scand 1997; 41: 914–22.
Scholz J, Hennes HJ, Steinfath M, et al. Tropisetron or ondansetron compared with placebo for prevention of postoperative nausea and vomiting. Eur J Anaesthesiol 1998; 15: 676–85.
Tsui SL, Ng KF, Wong LC, Tang GW, Pun TC, Yang JC. Prevention of postoperative nausea and vomiting in gynaecological laparotomies: a comparison of tropisetron and ondansetron. Anaesth Intensive Care 1999; 27: 471–6.
Jokela R, Koivuranta M, Kangas-Saarela T, Purhonen S, Alahuhta S. Oral ondansetron, tropisetron or metoclopramide to prevent postoperative nausea and vomiting: a comparison in high-risk patients undergoing thyroid or parathyroid surgery. Acta Anaesthesiol Scand 2002; 46: 519–24.
Fujii Y, Saitoh Y, Tanaka H, Toyooka H. Comparison of ramosetron and granisetron for preventing postoperative nausea and vomiting after gynecologic surgery. Anesth Analg 1999; 89: 476–9.
Fujii Y, Saitoh Y, Tanaka H, Toyooka H. Ramosetron vs granisetron for the prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy. Can J Anesth 1999; 46: 991–3.
Fujii Y, Tanaka H. Comparison of granisetron and ramosetron for the prevention of nausea and vomiting after thyroidectomy. Clin Ther 2002; 24: 766–72.
Hill RP, Lubarsky DA, Phillips-Bute B, et al. Costeffectiveness of prophylactic antiemetic therapy with ondansetron, droperidol, or placebo. Anesthesiology 2000; 92: 958–67.
Fischler M, Bonnet F, Trang H, et al. The pharmacokinetics of droperidol in anesthetized patients. Anesthesiology 1986; 64: 486–9.
Culebras X, Corpataux JB, Gaggero G, Tramer MR. The antiemetic efficacy of droperidol added to morphine patient-controlled analgesia: a randomized, controlled, multicenter dose-finding study. Anesth Analg 2003; 97: 816–21.
Fortney JT, Gan TJ, Graczyk S, et al. A comparison of the efficacy, safety, and patient satisfaction of ondansetron versus droperidol as antiemetics for elective outpatient surgical procedures. S3A-409 and S3A-410 Study Groups. Anesth Analg 1998; 86: 731–8.
Habib AS, Gan TJ. Food and drug administration black box warning on the perioperative use of droperidol: a review of the cases. Anesth Analg 2003; 96: 1377–9.
Gan TJ, White PF, Scuderi PE, Watcha MF, Kovac A. FDA “black box” warning regarding use of droperidol for postoperative nausea and vomiting: is it justified? (Letter) Anesthesiology 2002; 97: 287.
Rowbotham DJ. Current management of postoperative nausea and vomiting. Br J Anaesth 1992; 69: 46S-59S.
Quaynor H, Raeder JC. Incidence and severity of postoperative nausea and vomiting are similar after metoclopramide 20 mg and ondansetron 8 mg given by the end of laparoscopic cholecystectomies. Acta Anaesthesiol Scand 2002; 46: 109–13.
Bailey PL, Streisand JB, Pace NL, et al. Transdermal scopolamine reduces nausea and vomiting after outpatient laparoscopy. Anesthesiology 1990; 72: 977–80.
Ahmed AB, Hobbs GJ, Curran JP. Randomized, placebo-controlled trial of combination antiemetic prophylaxis for day-case gynaecological laparoscopic surgery. Br J Anaesth 2000; 85: 678–82.
Dundee JW, Assaf RA, Loan WB, Morrison JD. A comparison of the efficacy of cyclizine and perphenazine in reducing the emetic effects of morphine and pethidine. Br J Clin Pharmacol 1975; 2: 81–5.
Khalil S, Philbrook L, Rabb M, et al. Ondansetron/promethazine combination or promethazine alone reduces nausea and vomiting after middle ear surgery. J Clin Anesth 1999; 11: 596–600.
Howat DD. Anti-emetic drugs in anaesthesia. A double blind trial of two phenothiazine derivatives. Anaesthesia 1960; 15: 289–97.
Dryberg V, Johansen SH. Pre-anaesthetic medication with chlorpromazine. A comparison with morphine. Acta Anaesthesiol Scand 1958; 2: 133–47.
Dundee JW, Moore J, Love WJ, Nicholl RM, Clarke RS. Studies of drugs given before anaesthesia. VI: the phenothiazine derivatives. Br J Anaesth 1965; 37: 332–52.
Chen JJ, Frame DG, White TJ. Efficacy of ondansetron and prochlorperazine for the prevention of postoperative nausea and vomiting after total hip replacement or total knee replacement procedures. A randomized, double-blind, comparative trial. [erratum: Arch Intern Med 1999; 159: 615]. Arch Intern Med 1998; 158: 2124–8.
Splinter W, Roberts DJ. Prophylaxis for vomiting by children after tonsillectomy: dexamethasone versus perphenazine. Anesth Analg 1997; 85: 534–7.
Splinter WM, Rhine EJ. Prophylaxis for vomiting by children after tonsillectomy: ondansetron compared with perphenazine. Br J Anaesth 1998; 80: 155–8.
Kovac AL. Prevention and treatment of postoperative nausea and vomiting. Drugs 2000; 59: 213–43.
Fujii Y, Tanaka H, Toyooka H. The effects of dexamethasone on antiemetics in female patients undergoing gynecologic surgery. Anesth Analg 1997; 85: 913–7.
Liu K, Hsu CC, Chia YY. Effect of dexamethasone on postoperative emesis and pain. Br J Anaesth 1998; 80: 85–6.
Liu K, Hsu CC, Chia YY. The effect of dose of dexamethasone for antiemesis after major gynecological surgery. Anesth Analg 1999; 89: 1316–8.
Wang JJ, Ho ST, Lee SC, Liu YC, Ho CM. The use of dexamethasone for preventing postoperative nausea and vomiting in females undergoing thyroidectomy: a dose-ranging study. Anesth Analg 2000; 91: 1404–7
Wang JJ, Ho ST, Tzeng JI, Tang CS. The effect of timing of dexamethasone administration on its efficacy as a prophylactic antiemetic for postoperative nausea and vomiting. Anesth Analg 2000; 91: 136–9.
Price ML, Walmsley A, Swaine C, Ponte J. Comparison of a total intravenous anaesthetic technique using a propofol infusion, with an inhalational technique using enflurane for day case surgery. Anaesthesia 1988; 43: 84–7.
Doze VA, Shafer A, White PF. Propofol-nitrous oxide versus thiopental-isoflurane-nitrous oxide for general anesthesia. Anesthesiology 1988; 69: 63–71.
Lebenbom-Mansour MH, Pandit SK, Kothary SP, Randel GI, Levy L. Desflurane versus propofol anesthesia: a comparative analysis in outpatients. Anesth Analg 1993; 76: 936–41.
Kim SI, Han TH, Kil HY, Lee JS, Kim SC. Prevention of postoperative nausea and vomiting by continuous infusion of subhypnotic propofol in female patients receiving intravenous patient-controlled analgesia. Br J Anaesth 2000; 85: 898–900.
Gan TJ, El-Molem H, Ray J, Glass PS. Patient-controlled antiemesis: a randomized, double-blind comparison of two doses of propofol versus placebo. Anesthesiology 1999; 90: 1564–70.
Gan TJ, Glass PS, Howell ST, Grant AP, Ginsberg B. Determination of plasma concentrations of propofol associated with 50% reduction in postoperative nausea. Anesthesiology 1997; 87: 779–84.
Gardner CJ, Armour DR, Beattie DT, et al. GR205171: a novel antagonist with high affinity for the tachykinin NK1 receptor, and potent broad-spectrum anti-emetic activity. Regul Pept 1996; 65: 45–53.
Diemunsch P, Schoeffler P, Bryssine B, et al. Antiemetic activity of the NK1 receptor antagonist GR205171 in the treatment of established postoperative nausea and vomiting after major gynaecological surgery. Br J Anaesth 1999; 82: 274–6.
Gesztesi Z, Scuderi PE, White PF, et al. Substance P (Neurokinin-1) antagonist prevents postoperative vomiting after abdominal hysterectomy procedures. Anesthesiology 2000; 93: 931–7.
Splinter W, Noel LP, Roberts D, Rhine E, Bonn G, Clarke W. Antiemetic prophylaxis for strabismus surgery. Can J Ophthalmol 1994; 29: 224–6.
Splinter WM, MacNeill HB, Menard EA, Rhine EJ, Roberts DJ, Gould MH. Midazolam reduces vomiting after tonsillectomy in children. Can J Anaesth 1995; 42: 201–3.
Khalil SN, Berry JM, Howard G, et al. The antiemetic effect of lorazepam after outpatient strabismus surgery in children. Anesthesiology 1992; 77: 915–9.
Prasad V, Till CB, Smith A. Midazolam ⊕n antiemetic? (Letter) Anaesthesia 2002; 57: 415.
Di Florio T. The use of midazolam for persistent postoperative nausea and vomiting. Anaesth Intensive Care 1992; 20: 383–6.
Di Florio T, Goucke CR. The effect of midazolam on persistent postoperative nausea and vomiting. Anaesth Intensive Care 1999; 27: 38–40.
Rothenberg DM, Parnass SM, Litwack K, McCarthy RJ, Newman LM. Efficacy of ephedrine in the prevention of postoperative nausea and vomiting. Anesth Analg 1991; 72: 58–61.
Naguib K, Osman HA, Al-Khayat HC, Zikri AM. Prevention of post-operative nausea and vomiting following laparoscopic surgery. Ephedrine vs propofol. Middle East J Anesthesiol 1998; 14: 219–30.
Hagemann E, Halvorsen A, Holgersen O, Tveit T, Raeder JC. Intramuscular ephedrine reduces emesis during the first three hours after abdominal hysterectomy. Acta Anaesthesiol Scand 2000; 44: 107–11.
Mikawa K, Nishina K, Maekawa N, Asano M, Obara H. Oral clonidine premedication reduces vomiting in children after strabismus surgery. Can J Anaesth 1995; 42: 977–81.
Oddby-Muhrbeck E, Eksborg S, Bergendahl HT, Muhrbeck O, Lonnqvist PA. Effects of clonidine on postoperative nausea and vomiting in breast cancer surgery. Anesthesiology 2002; 96: 1109–14.
Goll V, Akca O, Greif R, et al. Ondansetron is no more effective than supplemental intraoperative oxygen for prevention of postoperative nausea and vomiting. Anesth Analg 2001; 92: 112–7.
Greif R, Laciny S, Rapf B, Hickle RS, Sessler DI. Supplemental oxygen reduces the incidence of postoperative nausea and vomiting. Anesthesiology 1999; 91: 1246–52.
Purhonen S, Turunen M, Ruohoaho UM, Niskanen M, Hynynen M. Supplemental oxygen does not reduce the incidence of postoperative nausea and vomiting after ambulatory gynecologic laparoscopy. Anesth Analg 2003; 96: 91–6.
Yogendran S, Asokumar B, Cheng DC, Chung F. A prospective randomized double-blinded study of the effect of intravenous fluid therapy on adverse outcomes on outpatient surgery. Anesth Analg 1995; 80: 682–6.
Moretti EW, Robertson KM, El-Moalem H, Gan TJ. Intraoperative colloid administration reduces postoperative nausea and vomiting and improves postoperative outcomes compared with crystalloid administration. Anesth Analg 2003; 96: 611–7.
Boehler MM, Mitterschiffthaler GM, Schlager A. Korean hand acupressure reduces postoperative nausea and vomiting after gynecological laparoscopic surgery. Anesth Analg 2002; 94: 872–5.
Schlager A, Offer T, Baldissera I. Laser stimulation of acupuncture point P6 reduces postoperative vomiting in children undergoing strabismus surgery. Br J Anaesth 1998; 81: 529–32.
Rusy LM, Hoffman GM, Weisman SJ. Electroacupuncture prophylaxis of postoperative nausea and vomiting following pediatric tonsillectomy with or without adenoidectomy. Anesthesiology 2002; 96: 300–5.
Somri M, Vaida SJ, Sabo E, Yassain G, Gankin I, Gaitini LA. Acupuncture versus ondansetron in the prevention of postoperative vomiting. A study of children undergoing dental surgery. Anaesthesia 2001; 56: 927–32.
Gan TJ, Parrillo S, Fortney J, Georgiade G. Comparison of electroacupuncture and ondansetron for the prevention of postoperative nausea and vomiting. Anesthesiology 2001; 95: A22 (abstract).
Coloma M, White PF, Ogunnaike BO, et al. Comparison of acustimulation and ondansetron for the treatment of established postoperative nausea and vomiting. Anesthesiology 2002; 97: 1387–92.
White PF, Issioui T, Hu J, et al. Comparative efficacy of acustimulation (ReliefBand®) versus ondansetron (Zofran®) in combination with droperidol for preventing nausea and vomiting. Anesthesiology 2002; 97: 1075–81.
Enqvist B, Bjorklund C, Engman M, Jakobsson J. Preoperative hypnosis reduces postoperative vomiting after surgery of the breasts. A prospective, randomized and blinded study. Acta Anaesthesiol Scand 1997; 41: 1028–32.
Ernst E, Pittler MH. Efficacy of ginger for nausea and vomiting: a systematic review of randomized clinical trials. Br J Anaesth 2000; 84: 367–71.
Habib AS, Gan TJ. Combination therapy for postoperative nausea and vomiting —a more effective prophylaxis? Ambulatory Surgery 2001; 9: 59–71.
Habib AS, Gan TJ. Combination antiemetic. What is the evidence? Int Anesthesiol Clin Fall 2003; 41: 119–44.
Habib AS, El-Moalem HE, Gan TJ. Is the combination of 5-HT3 receptor antagonists with droperidol or dexamethasone more effective than each agent alone for PONV prophylaxis? Anesthesiology 2001; 95: A20 (abstract).
Sanchez-Ledesma MJ, Lopez-Olaondo L, Pueyo FJ, Carrascosa F, Ortega A. A comparison of three antiemetic combinations for the prevention of postoperative nausea and vomiting. Anesth Analg 2002; 95: 1590–5.
Habib AS, El-Moalem HE, Gan TJ. The efficacy of the 5-HT3 receptor antagonists combined with droperidol for PONV prophylaxis is similar to their combination with dexamethasone. A meta-analysis of randomized controlled trials. Can J Anesth 2004; 51: 311–19.
Habib AS. Midazolam ⊕n anti-emetic? (Letter) Anaesthesia 2002; 57: 725.
Scuderi PE, James RL, Harris L, Mims GR 3rd. Multimodal antiemetic management prevents early postoperative vomiting after outpatient laparoscopy. Anesth Analg 2000; 91: 1408–14.
Hammas B, Thorn SE, Wattwil M. Superior prolonged antiemetic prophylaxis with a four-drug multimodal regimen —comparison with propofol or placebo. Acta Anaesthesiol Scand 2002; 46: 232–7.
Eberhart LH, Mauch M, Morin AM, Wulf H, Geldner G. Impact of a multimodal anti-emetic prophylaxis on patient satisfaction in high-risk patients for postoperative nausea and vomiting. Anaesthesia 2002; 57: 1022–7.
Tang J, Chen L, White PF, et al. Recovery profile, costs, and patient satisfaction with propofol and sevoflurane for fast-track office-based anesthesia. Anesthesiology 1999; 91: 253–61.
Wu CL, Berenholtz SM, Pronovost PJ, Fleisher LA. Systematic review and analysis of postdischarge symptoms after outpatient surgery. Anesthesiology 2002; 96: 994–1003.
Carroll NV, Miederhoff P, Cox FM, Hirsch JD. Postoperative nausea and vomiting after discharge from outpatient surgery centers. Anesth Analg 1995; 80: 903–9.
Gan TJ, Franiak R, Reeves J. Ondansetron orally disintegrating tablet versus placebo for the prevention of postdischarge nausea and vomiting after ambulatory surgery. Anesth Analg 2002; 94: 1199–200.
Zarate E, Mingus M, White PF, et al. The use of transcutaneous acupoint electrical stimulation for preventing nausea and vomiting after laparoscopic surgery. Anesth Analg 2001; 92: 629–35.
Gupta A, Wu CL, Elkassabany N, Krug CE, Parker SD, Fleisher LA. Does the routine prophylactic use of antiemetics affect the incidence of postdischarge nausea and vomiting following ambulatory surgery? A systematic review of randomized controlled trials. Anesthesiology 2003; 99: 488–95.
Tramer MR, Phillips C, Reynolds DJ, McQuay HJ, Moore RA. Cost-effectiveness of ondansetron for postoperative nausea and vomiting. Anaesthesia 1999; 54: 226–34.
Frighetto L, Loewen PS, Dolman J, Marra CA. Costeffectiveness of prophylactic dolasetron or droperidol vs rescue therapy in the prevention of PONV in ambulatory gynecologic surgery. Can J Anesth 1999; 46: 536–43.
Tang J, Watcha MF, White PF. A comparison of costs and efficacy of ondansetron and droperidol as prophylactic antiemetic therapy for elective outpatient gynecologic procedures. Anesth Analg 1996; 83: 304–13.
Watcha MF, Smith I. Cost-effectiveness analysis of antiemetic therapy for ambulatory surgery. J Clin Anesth 1994; 6: 370–7.
Habib AS, White WD, Eubanks S, Papas TN, Gan TJ. A randomized comparison of a multimodal management strategy versus combination antiemetics for the prevention of postoperative nausea and vomiting. Anesth Analg 2004 (in press).
Kazemi-Kjellberg F, Henzi I, Tramer MR. Treatment of established postoperative nausea and vomiting: a quantitative systematic review. BMC Anesthesiol 2001; 1: 2.
Kovac AL, O’Connor TA, Pearman MH, et al. Efficacy of repeat intravenous dosing of ondansetron in controlling postoperative nausea and vomiting: a randomized, double-blind, placebo-controlled multicenter trial. J Clin Anesth 1999; 11: 453–9.
Hill RP, Soppitt AJ, Gan TJ. The effectiveness of rescue antiemetics in patients who received a prophylactic antiemetic. Anesth Analg 2000; 90: S8 (abstract).
Carmichael J, Keizer HJ, Cupissol D, Milliez J, Scheidel P, Schindler AE. Use of granisetron in patients refractory to previous treatment with antiemetics. Anticancer Drugs 1998; 9: 381–5.
de Wit R, de Boer AC, vd Linden GH, Stoter G, Sparreboom A, Verweiy J. Effective cross-over to granisetron after failure to ondansetron, a randomized double blind study in patients failing ondansetron plus dexamethasone during the first 24 hours following highly emetogenic chemotherapy. Br J Cancer 2001; 85: 1099–101.
Tramer MR, Moore RA, Reynolds DJ, McQuay HJ. A quantitative systematic review of ondansetron in treatment of established postoperative nausea and vomiting. BMJ 1997; 314: 1088–92.
Diemunsch P, Conseiller C, Clyti N, Mamet JP. Ondansetron compared with metoclopramide in the treatment of established postoperative nausea and vomiting. The French Ondansetron Study Group. Br J Anaesth 1997; 79: 322–6.
Scuderi PE, James RL, Harris L, Mims GR 3rd. Antiemetic prophylaxis does not improve outcomes after outpatient surgery when compared to symptomatic treatment. Anesthesiology 1999; 90: 360–71.
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Disclosures: The following author has conflicts of interest or potential conflicts of interest. T.J. Gan -speaker’s bureau: Pharmacia, Abbott, GlaxoSmithKline, Aspect, and Roche; consultant: Pharmacia, Abbott, Roche, and GlaxoSmithKline.
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Habib, A.S., Gan, T.J. Evidence-based management of postoperative nausea and vomiting: a review. Can J Anesth 51, 326–341 (2004). https://doi.org/10.1007/BF03018236
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DOI: https://doi.org/10.1007/BF03018236