Hostname: page-component-7479d7b7d-m9pkr Total loading time: 0 Render date: 2024-07-08T17:29:05.008Z Has data issue: false hasContentIssue false
  • English
  • Français

Algorithms for the prevention of postoperative nausea and vomiting: an efficacy and efficiency simulation

Published online by Cambridge University Press:  01 October 2007

P. Kranke ,
L. H. Eberhart ,
T. J. Gan ,
N. Roewer  and
M. R. Tramèr
P. Kranke*
Affiliation:
University of Würzburg, Department of Anesthesiology, Würzburg, Germany
L. H. Eberhart
Affiliation:
Philipps-University of Marburg, Department of Anesthesiology and Intensive Care, Marburg, Germany
T. J. Gan
Affiliation:
Duke University Medical Center, Department of Anesthesiology, Durham, NC, USA
N. Roewer
Affiliation:
University of Würzburg, Department of Anesthesiology, Würzburg, Germany
M. R. Tramèr
Affiliation:
Geneva University Hospitals, Division of Anesthesiology, Genève, Switzerland
*
Correspondence to: Peter Kranke, Department of Anesthesiology, University of Würzburg, Oberdürrbacher Str. 6, D-97080 Würzburg, Germany. E-mail: [email protected]; Tel: +49/(0)931 201 0 (switchboard operator) or +49/(0)931 201 30115 (office); Fax: +49/(0)931 4042202
Get access

Summary

Background and objective

A number of algorithms for the prevention of postoperative nausea and vomiting have been proposed. Their efficacy and efficiency remains unclear.

Methods

We assumed that four antiemetic interventions were similarly effective and achieved additive effects when combined. We applied published and hypothetical algorithms for the prevention of postoperative nausea and vomiting to patient populations with different baseline risks. As indicators of efficacy and efficiency we computed for each baseline risk and each algorithm the total number of patients receiving prophylaxis, the total number of administered interventions, the cumulative 24 h incidence of postoperative nausea and vomiting, and an Efficiency Index (i.e. the number of administered interventions divided by the achieved absolute risk reduction). This was done for cohorts of 100 patients.

Results

Ten algorithms were tested in seven populations with different baseline risks. Algorithms were fixed (⩾ 1 intervention given to all patients, independent of baseline risk) or risk-adapted (⩾ 1 intervention administered depending on the presumed baseline risk). Risk-adapted algorithms were escalating (the greater the baseline risk, the more interventions are given) or dichotomous (a fixed number of interventions is given to high-risk patients only). With some algorithms, when applied to selected patient populations, the average postoperative nausea and vomiting incidence could be decreased below 15%; however, none produced consistent postoperative nausea and vomiting incidences below 20% across all populations. With all, the number of administered antiemetic interventions was the major factor for improved efficacy. Depending on the baseline risk, some algorithms offered potential towards improved efficiency.

Conclusions

Despite improved knowledge on risk factors and antiemetic strategies, none of the tested algorithms completely prevents postoperative nausea and vomiting and none is universally applicable. Anesthesiologists should try to identify the most useful antiemetic strategy for a specific setting. That strategy may be prophylactic or therapeutic or a combination of both, and it should consider institutional policies and individual baseline risks.

Keywords

Information science, computer simulationHEALTHCARE EVALUATION MECHANISMS, meta-analysis, logistic regressionEVALUATION STUDIES, programme evaluationPOSTOPERATIVE COMPLICATIONS, postoperative nausea and vomitingQUALITY ASSURANCE, HEALTHCARE, practice guidelines
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 10 , October 2007 , pp. 856 - 867
Copyright
Copyright © European Society of Anaesthesiology 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Koivuranta, M, Läärä, E, Snare, L, Alahuhta, S. A survey of postoperative nausea and vomiting. Anaesthesia 1997; 52: 443–449.CrossRefGoogle ScholarPubMed
2.Apfel, CC, Läärä, 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.CrossRefGoogle ScholarPubMed
3.Eberhart, LH, Geldner, G, Kranke, P et al. . The development and validation of a risk score to predict the probability of postoperative vomiting in pediatric patients. Anesth Analg 2004; 99: 1630–1637.CrossRefGoogle ScholarPubMed
4.Tramèr, MR. Rational control of PONV – the rule of three. Can J Anaesth 2004; 51: 283–285.CrossRefGoogle ScholarPubMed
5.Tramèr, MR. Strategies for postoperative nausea and vomiting. Best Pract Res Clin Anaesthesiol 2004; 18: 693–701.CrossRefGoogle ScholarPubMed
6.Apfel, CC, Roewer, N. Risk assessment of postoperative nausea and vomiting. Int Anesthesiol Clin 2003; 41: 13–32.CrossRefGoogle ScholarPubMed
7.Pierre, S, Corno, G, Benais, H, Apfel, CC. A risk score-dependent antiemetic approach effectively reduces postoperative nausea and vomiting – a continuous quality improvement initiative. Can J Anaesth 2004; 51: 320–325.CrossRefGoogle ScholarPubMed
8.Biedler, A, Wermelt, J, Kunitz, O et al. . A risk adapted approach reduces the overall institutional incidence of postoperative nausea and vomiting. Can J Anaesth 2004; 51: 13–19.CrossRefGoogle ScholarPubMed
9.Rüsch, D, Eberhart, L, Biedler, A, Dethling, J, Apfel, CC. Prospective application of a simplified risk score to prevent postoperative nausea and vomiting. Can J Anaesth 2005; 52: 478–484.CrossRefGoogle ScholarPubMed
10.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: 659–668.CrossRefGoogle Scholar
11.Apfel, CC, Korttila, K, Abdalla, M et al. . A factorial trial of six interventions for the prevention of postoperative nausea and vomiting. N Engl J Med 2004; 350: 2441–2451.CrossRefGoogle ScholarPubMed
12.Tramèr, MR, Moore, A, McQuay, H. Propofol anaesthesia and postoperative nausea and vomiting: quantitative systematic review of randomized controlled studies. Br J Anaesth 1997; 78: 247–255.CrossRefGoogle ScholarPubMed
13.Henzi, I, Walder, B, Tramèr, MR. Dexamethasone for the prevention of postoperative nausea and vomiting: a quantitative systematic review. Anesth Analg 2000; 90: 186–194.CrossRefGoogle ScholarPubMed
14.Tramèr, 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 placebo-controlled trials. Anesthesiology 1997; 87: 1277–1289.CrossRefGoogle ScholarPubMed
15.Kranke, P, Apfel, CC, Eberhart, LH, Georgieff, M, Roewer, N. The influence of a dominating centre on a quantitative systematic review of granisetron for preventing postoperative nausea and vomiting. Acta Anaesthesiol Scand 2001; 45: 659–670.CrossRefGoogle ScholarPubMed
16.Kranke, P, Eberhart, LH, Apfel, CC, Broscheit, J, Geldner, G, Roewer, N. Tropisetron for prevention of postoperative nausea and vomiting: a quantitative systematic review. Der Anaesthesist 2002; 51: 805–814.CrossRefGoogle ScholarPubMed
17.Kranke, P, Eberhart, LHJ, Morin, AM, Roewer, N. Dolasetron for prevention of postoperative nausea and vomiting: A meta-analysis of randomized controlled trials. Anaesthesiol Intensivmed 2002; 43: 413–427.Google Scholar
18.Henzi, I, Sonderegger, J, Tramèr, MR. Efficacy, dose–response, and adverse effects of droperidol for prevention of postoperative nausea and vomiting. Can J Anaesth 2000; 47: 537–551.CrossRefGoogle ScholarPubMed
19.Büttner, M, Walder, B, von Elm, E, Tramèr, MR. Is low-dose haloperidol a useful antiemetic?: a meta-analysis of published and unpublished randomized trials. Anesthesiology 2004; 101: 1454–1463.CrossRefGoogle ScholarPubMed
20.Kranke, P, Eberhart, LH. Nausea and vomiting after anesthesia – what is certain in prophylaxis and treatment? Anasthesiol Intensivmed Notfallmed Schmerzther 2005; 40: 549–554.CrossRefGoogle ScholarPubMed
21.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: 133–143.CrossRefGoogle ScholarPubMed
22.Tramèr, MR, Walder, B. Number needed to treat (or harm). World J Surg 2005; 29: 576–581.CrossRefGoogle Scholar
23.Watcha, MF. The cost-effective management of postoperative nausea and vomiting. Anesthesiology 2000; 92: 931–933.CrossRefGoogle ScholarPubMed
24.Gan, TJ. Postoperative nausea and vomiting – can it be eliminated? JAMA 2002; 287: 1233–1236.CrossRefGoogle ScholarPubMed
25.Habib, AS, Gan, TJ. Evidence-based management of postoperative nausea and vomiting: a review. Can J Anaesth 2004; 51: 326–341.CrossRefGoogle ScholarPubMed
26.Pierre, S, Benais, H, Pouymayou, J. Apfel's simplified score may favourably predict the risk of postoperative nausea and vomiting. Can J Anaesth 2002; 49: 237–242.CrossRefGoogle ScholarPubMed
27.Gan, TJ, Meyer, T, Apfel, CC et al. . Consensus guidelines for managing postoperative nausea and vomiting. Anesth Analg 2003; 97: 62–71.CrossRefGoogle ScholarPubMed
28.Apfel, CC, Kranke, P, Eberhart, LH, Roos, A, Roewer, N. Comparison of predictive models for postoperative nausea and vomiting. Br J Anaesth 2002; 88: 234–240.CrossRefGoogle ScholarPubMed
29.van den Bosch, JE, Kalkman, CJ, Vergouwe, Y et al. . Assessing the applicability of scoring systems for predicting postoperative nausea and vomiting. Anaesthesia 2005; 60: 323–331.CrossRefGoogle ScholarPubMed
30.van den Bosch, JE, Moons, KG, Bonsel, GJ, Kalkman, CJ. Does measurement of preoperative anxiety have added value for predicting postoperative nausea and vomiting? Anesth Analg 2005; 100: 1525–1532.CrossRefGoogle ScholarPubMed
31.Apfel, CC, Kranke, P, Greim, CA, Roewer, N. What can be expected from risk scores for predicting postoperative nausea and vomiting? Br J Anaesth 2001; 86: 822–827.CrossRefGoogle ScholarPubMed
32.Engel, JM, Junger, A, Hartmann, B et al. . Performance and customization of 4 prognostic models for postoperative onset of nausea and vomiting in ear, nose, and throat surgery. J Clin Anesth 2006; 18: 256–263.CrossRefGoogle ScholarPubMed
33.Scuderi, PE, James, RL, Harris, L, IIIMims, GR. Multimodal antiemetic management prevents early postoperative vomiting after outpatient laparoscopy. Anesth Analg 2000; 91: 1408–1414.CrossRefGoogle ScholarPubMed
34.Scuderi, PE, James, RL, Harris, L, IIIMims, GR. Antiemetic prophylaxis does not improve outcomes after outpatient surgery when compared to symptomatic treatment. Anesthesiology 1999; 90: 360–371.CrossRefGoogle Scholar
35.Kazemi-Kjellberg, F, Henzi, I, Tramèr, MR. Treatment of established postoperative nausea and vomiting: a quantitative systematic review. BMC Anesthesiol 2001; 1: 2.CrossRefGoogle ScholarPubMed
36.Rüsch, D, Arndt, C, Martin, H et al. . Dexamethasone enhances antiemetic efficacy of dolasetron and haloperidol for treatment of established PONV. Eur J Anaesthesiol 2006; 23: A-59.Google Scholar