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Canadian Journal of Anesthesia

, Volume 47, Issue 6, pp 537–551 | Cite as

Efficacy, dose-response, and adverse effects of droperidol for prevention of postoperative nausea and vomiting

  • Iris Henzi
  • Jürg Sonderegger
  • Martin R. TramèrEmail author
Systematic Review

Abstract

Purpose: To estimate the efficacy and harm produced by droperidol in the prevention of postoperative nausea and vomiting (PONV).

Methods: Systematic search (MEDLINE, EMBASE, Cochrane library, hand-searching, bibliographies, all languages, up to May 1999) for randomised comparisons of droperidol with placebo in surgical patients. Relevant end points were prevention of early PONV (up to six hours postoperatively), and late PONV (24 hr), and adverse effects. Combined data were analysed using relative risk and NNT.

Results: In 76 trials, 5,351 patients received 24 different regimens of droperidol. The average incidence of early and late PONV in controls was 34% and 51%, respectively. Droperidol was more efficacious than placebo in preventing PONV. In adults, the anti-nausea effect was short-lived, and there was no dose-responsiveness; with 0.25 to 0.30 mg the number-needed-to-treat (NNT) to prevent early nausea was 5. For both early and late anti-vomiting efficacy there was dose-responsiveness; best efficacy was with 1.5 mg to 2.5 mg (NNT, 7). In children, there was dose-responsiveness; best efficacy was with 75µg·kg−1 (NNT to prevent early and late vomiting, 4). Two children had extrapyramidal symptoms with droperidol (NNT in children, 91; in any patient, 408). There was dose-responsiveness for sedation and drowsiness (with 2.5 mg the NNT was 7.8). Droperidol prevented post-operative headache (NNT, −25).

Conclusions: Droperidol is anti-emetic in the surgical setting. The effect on nausea is short-lived but more pronounced than the effect on vomiting. Sedation and drowsiness are dose-dependent, extrapyramidal symptoms are rare, and there is a protective effect against headache.

Keywords

Ondansetron Metoclopramide Granisetron Droperidol Extrapyramidal Symptom 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Résumé

Objectif: Évaluer l’efficacité et les effets négatifs du dropéridol utilisé pour la prévention de nausées et de vomissements postopératoires (NVPO).

Méthode: Recherche documentaire systématique (MEDLINE, EMBASE, bibliothèque Cochrane, recherche manuelle, bibliographies, dans toutes les langues jusqu’à mai 1999) pour établir des comparaisons randomisées de dropéridol avec un placebo chez des patients de chirurgie. Les paramètres étudiés ont été la prévention des NVPO précoces (jusqu’à six heures après l’opération) et tardifs (24 h) et les effets indésirables. Les données combinées ont été analysées en utilisant le risque relatif et le nombre nécessaire au traitement (NNT).

Résultats: Pour 76 essais, 5 351 patients ont reçu 24 régimes différents de dropéridol. L’incidence moyenne de NVPO précoces et tardifs chez les témoins a été de 34 % et 51 %, respectivement. Le dropéridol a été plus efficace que le placebo pour prévenir les NVPO. Chez les adultes, l’effet anti-nausée a été de courte durée et il n’y a pas eu de réponse en fonction de la dose; avec 0,25 à 0,30 mg, le NNT pour prévenir les nausées précoces a été de 5. Pour prévenir efficacement les vomissements précoces et tardifs, il y avait une réponse dépendante de la dose; la plus efficace a été de 1,5 mg à 2,5 mg (NNT, 7). Chez les enfants, pas de réponse selon la dose; l’efficacité maximale a été notée avec 75µg·kg−1 (NNT pour prévenir les vomissements précoces et tardifs, 4). Deux enfants ont présenté des symptômes pyramidaux avec le dropéridol (NNT chez les enfants, 91; chez tous les patients, 408). Il n’y avait pas de réponse selon la dose pour la somnolence (avec 2,5 mg, le NNT était de 7,8). Le dropéridol a empêché les céphalées postopératoires (NNT, −25).

Conclusion: Le dropéridol est antiémétique en chirurgie. L’effet sur les nausées est bref, mais plus prononcé que l’effet sur les vomissements La sédation et la somnolence sont dose-dépendantes; les symptômes extrapyramidaux sont rares et il y a un effet protecteur contre les céphalées.

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Copyright information

© Canadian Anesthesiologists 2000

Authors and Affiliations

  • Iris Henzi
    • 2
  • Jürg Sonderegger
    • 1
  • Martin R. Tramèr
    • 2
    Email author
  1. 1.Abteilung ChirurgieKreisspital OberengadinSamedanSwitzerland
  2. 2.Division of AnaesthesiologyGeneva University HospitalsGeneva 14Switzerland

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