AGO-RE

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Nausées vomissements chir . Karen B 2000

Titre: Comparative Efficacy and Safety of Ondansetron, Droperidol, and Metoclopramide for Preventing Postoperative Nausea and Vomiting: A Meta-Analysis
Auteurs: Karen B. Domino, MD, MPH*, Emily A. Anderson, BS*, Nayak L. Polissar, PhD and Karen L. Posner, PhD*
*Department of Anesthesiology, University of Washington School of Medicine; and The Mountain-Whisper-Light Statistical Consulting, Seattle, Washington. (Address correspondence and reprint requests to Karen B. Domino, MD, Department of Anesthesiology, Box 356540, University of Washington, Seattle, WA 98195. Address e-mail to kdomino@u.washington.edu.)
Date:
Abstract: Postoperative nausea and vomiting are important causes of morbidity after anesthesia and surgery. We performed a meta-analysis of published, randomized, controlled trials to determine the relative efficacy and safety of ondansetron, droperidol, and metoclopramide for the prevention of postoperative nausea and vomiting. We performed a literature search of English references using both the MEDLINE database and a manual search. Double-blinded, randomized, controlled trials comparing the efficiency of the prophylactic administration of ondansetron, droperidol, and/or metoclopramide therapy during general anesthesia were included. A total of 58 studies were identified, of which 4 were excluded for methodological concerns. For each comparison of drugs, a pooled odds ratio (OR) with a 95% CI was calculated using a random effects model. Ondansetron (pooled OR 0.43, 95% CI 0.31, 0.61; P < 0.001) and droperidol (pooled OR 0.68, 95% CI 0.54, 0.85; P < 0.001) were more effective than metoclopramide in preventing vomiting. Ondansetron was more effective than droperidol in preventing vomiting in children (pooled OR 0.49; P = 0.004), but they were equally effective in adults (pooled OR 0.87; P = 0.45). The overall risk of adverse effects was not different among drug combinations. We conclude that ondansetron and droperidol are more effective than metoclopramide in reducing postoperative vomiting. Implications: We performed a systematic review of published, randomized, controlled trials to determine the relative efficacy and safety of ondansetron, droperidol, and metoclopramide for preventing postoperative nausea and vomiting. Ondansetron and droperidol were more effective than metoclopramide in reducing postoperative vomiting. The overall risk of adverse effects did not differ.

Mots clés: Ondansetron, Droperidol, Metoclopramide, nausea, nausée, vomissement, vomiting, chirurgie, surgery, postoperative, post opératoire

This article has been cited by other articles:

White, P. F., Watcha, M. F. (1999). Has the Use of Meta-Analysis Enhanced Our Understanding of Therapies for Postoperative Nausea and Vomiting?. Anesth Analg 88: 1200-1200 [Full Text]   
White, P. F., Watcha, M. F. (1999). Postoperative Nausea and Vomiting: Prophylaxis Versus Treatment. Anesth Analg 89: 1337-1337 [Full Text]   
Friedberg, B. L., Domino, K. B. (1999). Another Perspective on Postoperative Nausea and Vomiting • Response. Anesth Analg 89: 1589-1589 [Full Text]   
Schlager, A., Boehler, M., Pühringer, F. (2000). Korean hand acupressure reduces postoperative vomiting in children after strabismus surgery. Br J Anaesth 85: 267-270 [Abstract] [Full Text]   
(2000). Editorial: Postoperative nausea and vomiting--time for balanced antiemesis?. Br J Anaesth 85: 675-677 [Full Text]   



23/03/2008
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