Key result
Combined dexamethasone and ondansetron is associated with ~56% less postoperative nausea and vomiting in high-risk patients.
Why the study?
The effectiveness of multiple prophylactic antiemetics in preventing PONV in high-risk and very high-risk patients identified by the Korean predictive model was investigated.
Does a combination of dexamethasone and ondansetron reduce the incidence of PONV in high-risk surgical patients?
Cohort (n=2,830)
Single-blind
No
Does a combination of dexamethasone and ondansetron reduce the incidence of PONV in high-risk surgical patients?
Odds Ratio: 3.6 (95% CI 2.8–4.7)
Absolute Event Rate: 23% vs 52.1%
Absolute Risk Reduction: 29.1%
p-value: p=<0.001
Prophylactic administration of dexamethasone and ondansetron significantly reduces the incidence of postoperative nausea and vomiting in high-risk patients.
Multiple antiemetics may reduce PONV in model-identified high-risk patients; leaves open need for randomized confirmation before practice change.
It was previously reported that the Korean predictive model could be used to identify patients at high risk of postoperative nausea and vomiting (PONV). This study investigated whether PONV in the high-risk and very high-risk patients identified by the Korean predictive model could be prevented by multiple prophylactic antiemetics. A total of 2,456 patients were selected from our previous PONV study and assigned to the control group, and 374 new patients were recruited consecutively to the treatment group. Patients in each group were subdivided into two risk groups according to the Korean predictive model: high-risk group and very high-risk group. Patients in the treatment group received an antiemetic combination of dexamethasone 5 mg (minutes after induction) and ondansetron 4 mg (30 min before the end of surgery). The incidences of PONV were examined at two hours after the surgery in the postanesthetic care unit and, additionally, at 24 hr after the surgery in the ward, and were analyzed for any differences between the control and treatment groups. The overall incidence of PONV decreased significantly from 52.1% to 23.0% (p< or =0.001) after antiemetic prophylaxis. Specifically, the incidence decreased from 47.3% to 19.4% (p< or =0.001) in the high-risk group and from 61.3% to 28.3% (p< or =0.001) in the very high-risk group. Both groups showed a similar degree of relative risk reductions: 59.0% vs. 53.8% in the high-risk and very high-risk groups, respectively. The results of our study showed that the antiemetic prophylaxis with the combination of dexamethasone and ondansetron was effective in reducing the occurrence of PONV in both high-risk and very high-risk patients.
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Kim et al. (2007) conducted a cohort in Postoperative nausea and vomiting (PONV) (n=2,830). Dexamethasone and ondansetron combination vs. No prophylactic antiemetics (historical control) was evaluated on Incidence of postoperative nausea and vomiting (PONV) within 24 hours after surgery (OR 3.6, 95% CI 2.8-4.7, p=<0.001). Prophylactic administration of combined dexamethasone and ondansetron significantly reduced the overall incidence of postoperative nausea and vomiting from 52.1% to 23.0% in high-risk and very high-risk patients.
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