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Titolo:
Dexamethasone for the prevention of postoperative nausea and vomiting: A quantitative systematic review
Autore:
Henzi, I; Walder, B; Tramer, MR;
Indirizzi:
Univ Hosp Geneva, Dept Anaesthesiol Pharmacol & Surg Intens Care, Div Anaethesiol, CH-1211 Geneva 14, Switzerland Univ Hosp Geneva Geneva Switzerland 14 l, CH-1211 Geneva 14, Switzerland Univ Hosp Geneva, Dept Anaesthesiol Pharmacol & Surg Intens Care, Div Anaesthesiol Invest, CH-1211 Geneva, Switzerland Univ Hosp Geneva Geneva Switzerland CH-1211 CH-1211 Geneva, Switzerland
Titolo Testata:
ANESTHESIA AND ANALGESIA
fascicolo: 1, volume: 90, anno: 2000,
pagine: 186 - 194
SICI:
0003-2999(200001)90:1<186:DFTPOP>2.0.ZU;2-D
Fonte:
ISI
Lingua:
ENG
Soggetto:
PROPHYLACTIC ANTIEMETIC THERAPY; ONDANSETRON PLUS DEXAMETHASONE; CANCER-CHEMOTHERAPY; GYNECOLOGIC SURGERY; CONTROLLED TRIALS; CLINICAL-TRIALS; DOSE-RESPONSE; CHILDREN; EMESIS; TONSILLECTOMY;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
47
Recensione:
Indirizzi per estratti:
Indirizzo: Tramer, MR Univ Hosp Geneva, Dept Anaesthesiol Pharmacol & Surg Intens Care, Div Anaethesiol, 24 Rue Micheli du Crest, CH-1211 Geneva 14, SwitzerlandUniv Hosp Geneva 24 Rue Micheli du Crest Geneva Switzerland 14
Citazione:
I. Henzi et al., "Dexamethasone for the prevention of postoperative nausea and vomiting: A quantitative systematic review", ANESTH ANAL, 90(1), 2000, pp. 186-194

Abstract

The role of dexamethasone in the prevention of postoperative nausea and vomiting (PONV) is unclear. We reviewed efficacy and safety data of dexamethasone for prevention of PONV. A systematic search (MEDLINE, EMBASE, CochraneLibrary, hand searching,bibliographies, all languages, up to April 1999) was done for full reports of randomized comparisons of dexamethasone with other antiemetics or placebo in surgical patients. Relevant end points were prevention of early PONV (0 to 6 h postoperatively), late PONV (0 to 24 h), and adverse effects. Data from 1,946 patients from 17 trials were analyzed:598 received dexamethasone; 582 received ondansetron, granisetron, droperidol, metoclopramide, or perphenazine; 423 received a placebo; and 343 received a combination of dexamethasone with ondansetron or granisetron. With placebo, the incidence of early and late PONV was 35% and 50%, respectively. Sixteen different regimens of dexamethasone were tested, most frequently, 8or 10 mg IV in adults, and 1 or 1.5 mg/kg IV children. With these doses, the number needed to treat to prevent early and late vomiting compared with placebo in adults and children was 7.1 (95% CI 4.5 to 18), and 3.8 (2.9 to 5), respectively. In adults, the number needed to treat to prevent late nausea was 4.3 (2.3 to 26). The combination of dexamethasone with ondansetron or granisetron further decreased the risk of PONV; the number needed to treat to prevent late nausea and vomiting with the combined regimen compared with the 5-HT3 receptor antagonists alone was 7.7 (4.8 to 19) and 7.8 (4.1 to 66), respectively. There was a lack of data from comparisons with other antiemetics for sensible conclusions. There were no reports on dexamethasone-related adverse effects. Implications: When there is a high risk of postoperative nausea and vomiting, a single prophylactic dose of dexamethasone isantiemetic compared with placebo, without evidence of any clinically relevant toxicity in otherwise healthy patients. Late efficacy seems to be most pronounced. It is very likely that the best prophylaxis of postoperative nausea and vomiting currently available is achieved by combining dexamethasone with a 5-HT3 receptor antagonist. Optimal doses of this combination need to be identified.

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Documento generato il 20/09/20 alle ore 10:41:03