Dosis bajas de haloperidol en combinación con ondansetrón no son eficaces para la profilaxis de náuseas y vómitos postoperatorios en pacientes propicios a esta complicación / Low doses of haloperidol combined with ondansetron are not effective for prophylaxis of postoperative nausea and vomiting in susceptible patients

INTRODUCCIÓN: El objetivo de este estudio fue evaluar la eficacia y los efectos secundarios de distintas combinaciones de antieméticos para la profilaxis de náuseas y vómitos postoperatorios (NVPO) en pacientes propicios a presentarlos tras cirugía muy emetógena. MÉTODOS: Tras revisar retrospectivamente las historias clínicas de pacientes sometidos a cirugía electiva muy emetógena bajo anestesia general durante el periodo 2009 a 2011, seleccionamos 368 mujeres con puntuación de Apfel ≥ 3 y que recibieron una combinación de 2 antieméticos como profilaxis. Analizamos la incidencia de NVPO a las 2, 6, 12 y 24 h del postoperatorio, rescates antieméticos, patrón de aparición de NVPO, efectos secundarios y nivel de sedación. Valoramos la respuesta completa como ausencia de NVPO en las primeras 24 h. RESULTADOS: Ondansetrón 4 mg i.v. en combinación con dexametasona 8 mg i.v. (O&Dex), haloperidol 1mg i.v. (O&Hal1), haloperidol 2 mg i.v. (O&Hal2) o droperidol 1,25 mg i.v. (O&Dro) fueron las combinaciones más empleadas. La respuesta completa fue mayor en los grupos O&Dex: 68,5% (IC: 58-78); O&Hal2: 64,1% (IC: 53-74) y O&Dro 63% (IC: 52-73) que en el grupo O&Hal1: 41,3% (IC: 31-52) (p < 0,01). La máxima incidencia de NVPO ocurrió entre las 2 y 6 h del postoperatorio. La incidencia de efectos secundarios fue mayor en el grupo O&Hal2. CONCLUSIONES: En pacientes con elevado riesgo de NVPO sometidos a cirugía muy emetógena, la eficacia de dosis bajas de haloperidol (1 mg) en combinación con ondansetrón es escasa. Dosis mayores (2 mg) son altamente eficaces, pero se asocian a una alta incidencia de efectos secundarios

BACKGROUND: In this observational study we reviewed the efficacy and side effects of different antiemetic combinations used in our hospital for postoperative nausea and vomiting (PONV) prophylaxis in high-risk women undergoing highly emetogenic surgery. METHODS: After reviewing retrospectively the medical records of patients undergoing highly emetogenic elective surgeries under general anaesthesia, we selected 368 women whose Apfel risk score was ≥ 3 and receiving a combination of 2 antiemetics for PONV prophylaxis. We analysed the incidence of PONV at 2, 6, 12 and 24 h after surgery, antiemetic rescue requirements, pattern of occurrence of PONV, side effects and level of sedation were also assessed. The main goal was complete response defined as no PONV within 24 h after surgery. RESULTS: Ondansetron 4 mg i.v. plus dexamethasone 8 mg i.v. (O&Dex), haloperidol 1 mg i.v. (O&Hal1), haloperidol 2 mg i.v. (O&Hal2) or droperidol 1.25mg i.v. (O&Dro) were the combinations most frequently used. The complete response was better in groups O&Dex: 68.5% (CI: 58-78), O&Hal2: 64.1% (CI: 53-74) and O&Dro 63% (CI: 52-73) than in group O&Hal1: 41.3% (CI: 31-52) (p < 0,01). Peak incidence of PONV occurred within the 2-6 h period. The incidence of side effects was higher in group O&Hal2. CONCLUSION: In high risk patients for PONV who underwent highly emetogenic surgeries, the efficacy of low-dose haloperidol (1mg) in combination is limited. Higher doses (2 mg) are more effective but its use is associated with a high incidence of side effects

Low doses of haloperidol combined with ondansetron are not effective for prophylaxis of postoperative nausea and vomiting in susceptible patients.

BACKGROUND: In this observational study we reviewed the efficacy and side effects of different antiemetic combinations used in our hospital for postoperative nausea and vomiting (PONV) prophylaxis in high-risk women undergoing highly emetogenic surgery. METHODS: After reviewing retrospectively the medical records of patients undergoing highly emetogenic elective surgeries under general anaesthesia, we selected 368 women whose Apfel risk score was ≥ 3 and receiving a combination of 2 antiemetics for PONV prophylaxis. We analysed the incidence of PONV at 2, 6, 12 and 24h after surgery, antiemetic rescue requirements, pattern of occurrence of PONV, side effects and level of sedation were also assessed. The main goal was complete response defined as no PONV within 24h after surgery. RESULTS: Ondansetron 4mg i.v. plus dexamethasone 8mg i.v. (O&Dex), haloperidol 1mg i.v. (O&Hal1), haloperidol 2mg i.v. (O&Hal2) or droperidol 1.25mg i.v. (O&Dro) were the combinations most frequently used. The complete response was better in groups O&Dex: 68.5% (CI: 58-78), O&Hal2: 64.1% (CI: 53-74) and O&Dro 63% (CI: 52-73) than in group O&Hal1: 41.3% (CI: 31-52) (p<0,01). Peak incidence of PONV occurred within the 2-6h period. The incidence of side effects was higher in group O&Hal2. CONCLUSION: In high risk patients for PONV who underwent highly emetogenic surgeries, the efficacy of low-dose haloperidol (1mg) in combination is limited. Higher doses (2mg) are more effective but its use is associated with a high incidence of side effects.