Publications (3)4.93 Total impact
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Article: Ondansetron has similar clinical efficacy against both nausea and vomiting.
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ABSTRACT: Ondansetron is widely believed to prevent postoperative vomiting more effectively than nausea. We analysed data from 5161 patients undergoing general anaesthesia who were randomly stratified to receive a combination of six interventions, one of which was 4 mg ondansetron vs placebo. For the purpose of this study a 20% difference in the relative risks for the two outcomes was considered clinically relevant. Nausea was reduced from 38% (969/2585) in the control to 28% (715/2576) in the ondansetron group, corresponding to a relative risk of 0.74, or a relative risk reduction of 26%. Vomiting was reduced from 17% (441/2585) to 11% (293/2576), corresponding to a relative risk of 0.67, or a relative risk reduction of 33%. The relative risks of 0.67 and 0.74 were clinically similar and the difference between them did not reach statistical significance. We thus conclude that ondansetron prevents postoperative nausea and postoperative vomiting equally well.Anaesthesia 03/2009; 64(2):147-51. · 2.96 Impact Factor -
Article: [A factorial trial of six interventions for the prevention of postoperative nausea and vomiting].
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ABSTRACT: Untreated, one third of patients who undergo surgery will have postoperative nausea and vomiting. Although many trials have been conducted, the relative benefits of prophylactic antiemetic interventions given alone or in combination remain unknown. In a randomized, controlled trial of factorial design, 5,199 patients at high risk for postoperative nausea and vomiting were randomly assigned to 1 of 64 possible combinations of 6 prophylactic interventions: 1) 4 mg of ondansetron or no ondansetron; 2) 4 mg of dexamethasone or no dexamethasone; 3) 1.25 mg of droperidol or no droperidol; 4) propofol or a volatile anesthetic; 5) nitrogen or nitrous oxide; 6) remifentanil or fentanyl. The primary aim parameter was nausea and vomiting within 24 h after surgery, which was evaluated blindly. Ondansetron, dexamethasone, and droperidol each reduced the risk of postoperative nausea and vomiting by about 26%, propofol reduced the risk by 19%, and nitrogen by 12%. The risk reduction with both of these agents (i.e., total intravenous anesthesia) was thus similar to that observed with each of the antiemetics alone. All the interventions acted independently of each other and independently of the patients' baseline risk. Consequently, the relative risks associated with the combined interventions could be estimated by multiplying the relative risks associated with each intervention. However, absolute risk reduction was a critical function of patients' baseline risk. Because antiemetic interventions are similarly effective and act independently, the safest or least expensive should be used first. Prophylaxis is rarely warranted in low-risk patients, moderate-risk patients may benefit from a single intervention, and multiple interventions should be reserved for high-risk patients.Der Anaesthesist 04/2005; 54(3):201-9. · 0.99 Impact Factor -
Article: Eine faktorielle Studie von 6 Interventionen zur Vermeidung von Übelkeit und Erbrechen nach Narkosen
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ABSTRACT: HintergrundOhne eine entsprechende Prophylaxe leidet ein Drittel aller Patienten nach einer Operation an belkeit und/oder Erbrechen (postoperative nausea and vomiting, PONV). Ziel der vorliegenden Untersuchung war die systematische Bestimmung der Effektivitt einer antiemetischen Prophylaxe mit Einzelmanahmen und ihrer Kombination in einem faktoriellen Design, das bis zu Dreifachinteraktionen zwischen allen antiemetischen Strategien analysieren knnen sollte.MethodikIn einer randomisierten, doppelblinden, kontrollierten Studie erhielten 5199Patienten mit einem hohen PONV-Risiko eine von 64 mglichen Kombinationen der folgenden 6Einzelmanahmen: 1) 4mg vs. kein Ondansetron; 2) 4mg vs. kein Dexamethason; 3) 1,25mg vs. kein Droperidol; 4) Propofol vs. volatile Ansthetika; 5) Luft vs. Lachgas; 6) Remifentanil vs. Fentanyl. Primrer Zielparameter war PONV innerhalb der ersten 24h nach Narkoseende.ErgebnisseAusgewertet wurden Daten von 5123Patienten (randomisiert fr 4Interventionen) bzw. 4086Patienten (randomisiert fr 6Interventionen). Die Verwendung von Remifentanil verminderte im Vergleich zu Fentanyl die Hufigkeit von PONV nicht. Ondansetron, Dexamethason und Droperidol reduzierten das relative PONV-Risiko um jeweils 26%. Propofol reduzierte das relative Risiko um 19% und Luft um 12%; die Kombination von Luft und Propofol zusammen als totale intravense Ansthesie (TIVA) war damit hnlich effektiv wie die Gabe eines Antiemetikums. Die Wirksamkeit aller Interventionen war unabhngig voneinander und unabhngig vom PONV-Risiko des Patienten. Damit lsst sich die relative Risikoreduktion nach Kombinationen antiemetischer Manahmen aus dem Produkt der einzelnen relativen Risikoreduktionen bestimmen. Folglich ist die absolute Risikoreduktion direkt abhngig vom jeweiligen PONV-Ausgangsrisiko des Patienten.SchlussfolgerungDie untersuchten antiemetischen Manahmen (inklusive TIVA) reduzieren das relative Risiko von PONV gleichermaen und unabhngig voneinander. Eine Prophylaxe ist daher selten bei einem niedrigen Risiko indiziert. Bei Patienten mit einem mittleren Risiko ist v.a. eine einfache Prophylaxe vernnftig. Bei Patienten mit einem hohen oder sehr hohen PONV-Risiko und bei Patienten, fr die PONV ein erhhtes medizinisches Risiko darstellt, erscheint eine Kombination antiemetischer Manahmen indiziert.BackgroundUntreated, one third of patients who undergo surgery will have postoperative nausea and vomiting. Although many trials have been conducted, the relative benefits of prophylactic antiemetic interventions given alone or in combination remain unknown.MethodsIn a randomized, controlled trial of factorial design, 5,199 patients at high risk for postoperative nausea and vomiting were randomly assigned to 1 of 64 possible combinations of 6 prophylactic interventions: 1) 4mg of ondansetron or no ondansetron; 2) 4mg of dexamethasone or no dexamethasone; 3) 1.25mg of droperidol or no droperidol; 4) propofol or a volatile anesthetic; 5) nitrogen or nitrous oxide; 6) remifentanil or fentanyl. The primary aim parameter was nausea and vomiting within 24h after surgery, which was evaluated blindly.ResultsOndansetron, dexamethasone, and droperidol each reduced the risk of postoperative nausea and vomiting by about 26%, propofol reduced the risk by 19%, and nitrogen by 12%. The risk reduction with both of these agents (i.e., total intravenous anesthesia) was thus similar to that observed with each of the antiemetics alone. All the interventions acted independently of each other and independently of the patients baseline risk. Consequently, the relative risks associated with the combined interventions could be estimated by multiplying the relative risks associated with each intervention. However, absolute risk reduction was a critical function of patients baseline risk.ConclusionsBecause antiemetic interventions are similarly effective and act independently, the safest or least expensive should be used first. Prophylaxis is rarely warranted in low-risk patients, moderate-risk patients may benefit from a single intervention, and multiple interventions should be reserved for high-risk patients.Der Anaesthesist 02/2005; 54(3):201-209. · 0.99 Impact Factor
