Characterization of the Use of Antiemetics in the Postoperative Period in Adult Patients Undergoing Surgery During January to May 2009 in a private hospital Clínica Bíblica in Costa Rica
DOI:
https://doi.org/10.51481/amc.v52i3.662Keywords:
nausea, vomiting, postoperative, anesthetics, antiemetics, postoperative nausea and vomitingAbstract
Aim: To evaluate and characterize the pharmaco-therapeutic approach with antiemetics during the postoperative, in adult patients undergoing surgery at a private hospital in Costa Rica (Hospital Clinica Biblica)
Methods: This is an observational, prospective and cohort study. Those patients who had surgery and received antiemetic prophylaxis before the procedure were selected (ages between 18 and 75 years) excluding those who had hospitalization shorter than 24 hours.
Results: Prophylactic antiemetic therapy in this private hospital utilizes granisetron, metoclopramide, dexamethasone, and dimenhydrinate, Granisetron, either alone or in combination, was the most used antiemetic in 81%. The combination most commonly used was dexamethasone and granisetron (57%). Without considering the surgical procedure, the incidence of postoperative nausea and vomiting (PONV) was 12% in patients taking granisetron, 25% with metoclopramide, 9% with dimenhydrinate, 13% with dexamethasone and 14% with other antiemetics. On the other hand, looking at the procedure, the incidence of PONV in patients undergoing orthopedic surgery was by 30%, and 28% in those after laparoscopic surgery Finally, in cases in which fentanyl was used as an anesthetic 18% of the patients presented PONV, whereas in patients cases were fentanyl was not used, the rate of was 9%.
Conclusion: Despite the widespread use of prophylactic antiemetics, PONV is still seen in the patients at this private hospital. In spite of the wealth of knowledge in this field, physicians have not yet found an algorithm capable of the total prevention of PONV. Individual risks and patient`s satisfaction should be taken into account. Further research on this matter must continue in order to unify and improve criteria of PONV treatment.
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References
González E, Delgado M. Estudio comparativo de la eficacia entre difenidol, ondansetrón y metoclopramida para la prevención y tratamiento de la náusea y el vómito postoperatorios en pacientes sometidos a intervención quirúrgica de oído y mastoides. Rev Esp Med Quir 2008; 13:153-8.
Bel I, Gambús P. Estratificación del riesgo, profilaxis y tratamiento de las náuseas y vómitos postoperatorios. Rev Esp Anestesiol 2006; 53: 301-311.
Ho K, Chiu J. Multimodal antiemetic therapy and emetic risk profiling. Ann Acad Med Singapore 2005; 34:196-205.
Kushwaha B, Chakraborty A, Agarwal J, Malick A, Bhushan S, Bhattacharya P. Comparative study of granisetron and ondansetron alone and their combination with dexamethasone, for prevention of PONV in middle ear surgery. Internet Journal of Anesthesiology 2007; 13:2.
Wattwil M, Thorn S, Lovqvist A. Dexamethasone is as effective as ondasetron for the prevention of postoperative nausea and vomiting following breast surgery. Acta Anaesthesiol Scand 2003; 47:823-827.
Montejo K, González I, Perdomo J, González E, Domech A. Prevención de las náuseas y vómitos postoperatorios. Rev méd electrón [Seriada en línea] 2007 [10 de enero 2009], 29(4).En:http:// www.cpimtz.sld.cu/revista%20medica/ano%202007/vol4%202007/ tema13.htm
Rincón D, Valero J. Prevención de la náusea y el vómito postoperatorios. Rev Col Anest 2007; 35: 293-300.
Fujii, Y. The Utility of antiemetics in the prevention and treatment of postoperative nausea and vomiting in aatients scheduled for laparoscopic cholecystectomy. Current Pharmaceutical Design 2005; 11: 3173-3183.
Teran L, Hawkin J. The effectiveness of inhalation isopropyl alcohol vs granisetron for the prevention of postoperative nausea and vomiting. AANA J 2007; 75: 417-422.
Hamdan G. Midazolam: Un antiemético efectivo después de la cirugía cardíaca. Anesth Analg 2004; 99:339-43.
Sánchez M, López L, Pueyo F, Carrascosa F, Ortega A. A comparison of three antiemetic combinations for the prevention of postoperative nausea and vomiting. Anesth Analg 2002; 95:1590-1595.
De la Torre A, Rubial M. Anestesia en cirugía ambulatoria. Criterios de alta hospitalaria. ANALES Sis San Navarra 1999; 22: 101-106.
Oksuz H, Zencirci B, Ezberci M. Comparison of the effectiveness of metoclopramide, ondasetron, and granisetron on the prevention of nausea and vomiting after laparoscopic cholecystectomy. J Laparoendosc Adv Surg Tech A. 2007 17: 6.
Lee A, Gin T, Lau A, Floria F. A Comparison of patients and health care professionals preferences for symptoms during immediate postoperative recovery and the management of postoperative nausea and vomiting. Anesth Analg 2005; 100:87-93.
Fujii, Y. Prophylaxis of postoperative nausea and vomiting in patients scheduled for breast surgery. Clin Drug Invest 2006; 26: 427-437.
Hannaoka K, Toyooka H, Ohashi Y. Efficacy of profilactic intravenous granisetron in postoperative emesis in adults. J Anesth 2004; 18:158165.
Kovac A. Management of postoperative nausea and vomiting in children. Pediatr Drugs 2007; 9: 47-69.
Ramírez D, Ros J. Prevención de las náuseas y vómitos postoperatorios en cirugía ginecológica mediante tres dosis fijas de metoclopramida, droperidol o placebo. Rev Esp Anestesiol 2001; 48: 2.
McKeage K, Simpson D, Wagstaff, A. Intravenous droperidol: A review of its use in the management of postoperative nausea and vomiting. Drugs 2006; 66: 2123-2147.
Piper S, Suttner S, Röhm K, Maleck W, Larbig E, Boldt J. Dolasetron, but not metoclopramide prevents nausea and vomiting in patients undergoing laparoscopic cholecystectomy. Can J Anesth 2002; 49: 1021-1028.
Abali H, Elik I. Tropisetron, ondansetron, and granisetron for control of chemotherapy-induced emesis in turkish cancer patients: A comparison of efficacy, side-effect profile, and cost. Cancer Invest 2007; 25:135-139.
Quaynor H, Raeder J. Incidence and severity of postoperative nausea and vomiting are similar after metoclopramide 20mg and ondansetron 8mg given by the end of laparoscopic cholecystectomies. Rev Acta Anaesthesiol Scand 2002; 46: 109-113.
Gupta V, Wakhloo R, Lahori V. Prophylactic antiemetic therapy with ondansetron, granisetron and metoclopramide in patients undergoing laparoscopic cholecystectomy under general anaesthesia. Internet Journal of Anesthesiology 2007; 14 :1-5.
Aapro M, Thuerlimann B. A randomized double-blind trial to compare the clinical efficacy of granisetron with metoclopramide both combined with dexamethasone in the prophylaxis of chemotherapyinduced delayed emesis. Ann Onc 2003; 14: 291-297.
Apfel C, Korttila K, Abdalla M, Kerger H, Turan A, Vedder I, Zernak C, et al. A factorial trial of six Interventions for the prevention of postoperative nausea and momiting. N Engl J Med 2004; 350: 24412451.
Hamadani M, Chaudhary L, Awan F, Khan J, Kojouri K, Ozer H, et al. Management of platinum-based chemotherapy induced acute nausea and vomiting: is there a superior serotonin receptor antagonist?. J Oncol Pharm Practice 2007; 13: 2.
Elhakim M, Nafie M, Mahmoud K, Atef A. Dexamethasone 8 mg in combination with ondansetron 4 mg appears to be the optimal dose for the prevention of nausea and vomiting after laparoscopic cholecystectomy. Can J Anesth 2002; 49: 922-926.
Smith I, Walley G, Bridgman. Omitting fentanyl reduces nausea and vomiting, without increasing pain, after sevoflurane for day surgery.
Eur J Anaesthesiol 2008 25: 790-799.
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