Nausea and vomiting are frequent after general anesthesia, the most important causes of morbidity after anesthesia and surgery are postoperative nausea and vomiting.
A comparative analysis of published articles was done to determine the relative efficacy and safety of ondansetron, droperidol, metoclopramide, dexamethasone, and intravenous crystalloid fluid for the prevention of postoperative nausea and vomiting. I performed a literature search of English references using both the MEDLINE database and a manual search. Double-blinded, randomized, controlled trials comparing the effect of these agents in reduction or prevention of postoperative nausea and vomiting.
A total of 60 studies were identified, of which 6 were excluded for methodological concerns. For each comparison of drugs, ondansetron (P < 0.001), droperidol (P < 0.001) were more effective than metoclopramide in preventing vomiting. We conclude that ondansetron and droperidol are more effective than metoclopramide in reducing postoperative nausea and vomiting. The incidence of vomiting was reduced in the intravenous administration of crystalloid 30 mg/kg in healthy adults (P = 0.001) and for dexamethasone is (P < 0.03).
In summary, both ondansetron and droperidol were more effective than metoclopramide, intravenous crystalloid fluid and dexamethasone in preventing postoperative vomiting.
Patient well-being after general anaesthesia: a prospective, randomized, controlled multicentre trial comparing intravenous and inhalation anaesthesia. Br J Anaesth 2003;91:631-6 (Abstract/freefull text).
Unanticipated admission to the hospital following ambulatory surgery. JAMA 1989;262:3008-1. abstract.
Unanticipated admission after ambulatory surgery: a prospective study. Can J Anaesth 1998;45:612-9 (Abstract/freefull text).
Postoperative nausea and vomiting: prophylaxis versus treatment (editorial). Anesth Analg 1999;89:1337-9.
Which clinical anesthesia outcomes are important to avoid? Anesth Analg 1999;89:652-8.(Abstract/freefull text).
A rational approach to the control of postoperative nausea and vomiting: evidence from systemic reviews. I. Efficacy and harm of antiemetic interventions, and methodological issues. Acta Anaesthesiol Scand 2001;45:4-1. (ISI. midline).
A prospective randomized double-blinded study of the effect of intravenous fluid therapy on adverse outcomes on outpatient surgery. Anesth Analg 1995;80:682-6 abstract.
Reducing the risk of major elective surgery: randomised controlled trial of preoperative optimisation of oxygen delivery. BMJ 1999;318:1099-10. (Abstract/freefull text).
Perioperative plasma volume expansion reduces the incidence of gut mucosal hypoperfusion during cardiac surgery. Arch Surg 1995;130:423-9 abstract.
A prospective randomized double-blinded study of the effect of intravenous fluid therapy on adverse outcomes on outpatient surgery. Anesth Analg 1995;80:682-6.
Goal-directed intraoperative fluid administration reduces length of hospital stay after major surgery. Anesthesiology 2002;97:820–medline.
British Journal of Anaesthesia 2004;93(3):381-85;doi:10.1093/bja/aeh219 free abstract.
Domino comparative efficacy and safety of ondansetron, droperidol, and metoclopramide for preventing postoperative nausea and vomiting: A meta-analysis. Anesth Analg 1999;88:1370.
Large trials vs. meta-analysis of smaller trials. JAMA 1996;276:1332-8 (abstract).
The practice of meta-analysis. J Clin Epidemiol 1995;48:149-5. Medline.
Discrepancies between meta-analyses and subsequent large randomized, controlled trials. N Engl J Med 1997;337:536-4. (Abstract/ freefull text).
Multimodal antiemetic management prevents early postoperative vomiting after outpatient laparoscopy. Anesth Analg 2000;91:1408-1. (Abstract/freefull text).
Antiemetic prophylaxis for office-based surgery: are the 5-HT3 receptor antagonists beneficial? Anesthesiology 2003;98:293-8 (ISI.midline).
The effect of timing of ondansetron administration on its efficacy, cost-effectiveness, and cost-benefit as a prophylactic antiemetic in the ambulatory setting. Anesth Analg 1998;86:274-82.absract.
The safety and efficacy of prophylactic ondansetron in patients undergoing modified radical mastectomy. Anesth Analg 1999;89:1340-4. (Abstract/freefull text).
Does the routine prophylactic use of antiemetics affect the incidence of postdischarge nausea and vomiting following ambulatory surgery? Anesthesiology 2003;99:488-9. (ISI.midline).
A factorial trial of six interventions for the prevention of postoperative nausea and vomiting. N Engl J Med 2004;350:2441–51(Abstract/freefull text).