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Haloperidol dose combined with dexamethasone for PONV prophylaxis in high-risk patients undergoing gynecological laparoscopic surgery: a prospective, randomized, double-blind, dose-response and placebo-controlled study.

Joo J, Park YG, Baek J, Moon YE - BMC Anesthesiol (2015)

Bottom Line: This study sought to identify which dose of haloperidol 1mg or 2mg could be combined with dexamethasone without adverse effects in high-risk patients undergoing gynecological laparoscopic surgery.The overall early (0-2 h) and late (2-24 h) incidences of nausea, vomiting, rescue anti-emetic administration, pain, and adverse effects (cardiac arrhythmias and extrapyramidal effects) were assessed postoperatively.In the PACU, group H2 had a higher sedation score than groups H1 and H0 (P < 0.001).

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, Republic of Korea. jiyo1004@catholic.ac.kr.

ABSTRACT

Background: Low-dose haloperidol is known to be effective for the prevention of postoperative nausea and vomiting (PONV). However, precise dose-response studies have not been completed, especially in patients at high risk for PONV who require combination therapy. This study sought to identify which dose of haloperidol 1mg or 2mg could be combined with dexamethasone without adverse effects in high-risk patients undergoing gynecological laparoscopic surgery.

Methods: Female adults (n = 150) with three established PONV risk factors based on Apfel's score were randomized into one of three study groups. At the end of anesthesia, groups H0, H1, and H2 were given intravenous (IV) saline, haloperidol 1 mg, and haloperidol 2 mg, respectively. All patients were given dexamethasone 5 mg during the induction of anesthesia. The overall early (0-2 h) and late (2-24 h) incidences of nausea, vomiting, rescue anti-emetic administration, pain, and adverse effects (cardiac arrhythmias and extrapyramidal effects) were assessed postoperatively. The sedation score was recorded in the postanesthesia care unit (PACU).

Results: The total incidence of PONV over 24 h was significantly lower in groups H1 (29 %) and H2 (24 %) than in group H0 (54 %; P = 0.003), but there was no significant difference between groups H1 and H2. In the PACU, group H2 had a higher sedation score than groups H1 and H0 (P < 0.001).

Conclusions: For high-risk PONV patients undergoing gynecological laparoscopic surgery, when used with dexamethasone, 1-mg haloperidol was equally effective as 2 mg in terms of preventing PONV with the less sedative effect.

Trial registration: ClinicalTrials.gov ( NCT01639599 ).

No MeSH data available.


Related in: MedlinePlus

CONSORT diagram showing the flow of participants
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Fig1: CONSORT diagram showing the flow of participants

Mentions: Of the 150 patients registered for the study, one was excluded due to an intra-operative conversion to laparotomy (Fig. 1). The remaining 149 patients, consisting of 50, 49, and 50 patients in groups H0, H1, and H2, respectively, completed the study. The patient characteristics, PONV risk factors, type of surgery, duration of anesthesia, intra-operative remifentanil use, 24-h postoperative PCA fentanyl use, postoperative pain severity, and rescue analgesic requirements were similar among the three groups (Table 1).Fig. 1


Haloperidol dose combined with dexamethasone for PONV prophylaxis in high-risk patients undergoing gynecological laparoscopic surgery: a prospective, randomized, double-blind, dose-response and placebo-controlled study.

Joo J, Park YG, Baek J, Moon YE - BMC Anesthesiol (2015)

CONSORT diagram showing the flow of participants
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4493951&req=5

Fig1: CONSORT diagram showing the flow of participants
Mentions: Of the 150 patients registered for the study, one was excluded due to an intra-operative conversion to laparotomy (Fig. 1). The remaining 149 patients, consisting of 50, 49, and 50 patients in groups H0, H1, and H2, respectively, completed the study. The patient characteristics, PONV risk factors, type of surgery, duration of anesthesia, intra-operative remifentanil use, 24-h postoperative PCA fentanyl use, postoperative pain severity, and rescue analgesic requirements were similar among the three groups (Table 1).Fig. 1

Bottom Line: This study sought to identify which dose of haloperidol 1mg or 2mg could be combined with dexamethasone without adverse effects in high-risk patients undergoing gynecological laparoscopic surgery.The overall early (0-2 h) and late (2-24 h) incidences of nausea, vomiting, rescue anti-emetic administration, pain, and adverse effects (cardiac arrhythmias and extrapyramidal effects) were assessed postoperatively.In the PACU, group H2 had a higher sedation score than groups H1 and H0 (P < 0.001).

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, Republic of Korea. jiyo1004@catholic.ac.kr.

ABSTRACT

Background: Low-dose haloperidol is known to be effective for the prevention of postoperative nausea and vomiting (PONV). However, precise dose-response studies have not been completed, especially in patients at high risk for PONV who require combination therapy. This study sought to identify which dose of haloperidol 1mg or 2mg could be combined with dexamethasone without adverse effects in high-risk patients undergoing gynecological laparoscopic surgery.

Methods: Female adults (n = 150) with three established PONV risk factors based on Apfel's score were randomized into one of three study groups. At the end of anesthesia, groups H0, H1, and H2 were given intravenous (IV) saline, haloperidol 1 mg, and haloperidol 2 mg, respectively. All patients were given dexamethasone 5 mg during the induction of anesthesia. The overall early (0-2 h) and late (2-24 h) incidences of nausea, vomiting, rescue anti-emetic administration, pain, and adverse effects (cardiac arrhythmias and extrapyramidal effects) were assessed postoperatively. The sedation score was recorded in the postanesthesia care unit (PACU).

Results: The total incidence of PONV over 24 h was significantly lower in groups H1 (29 %) and H2 (24 %) than in group H0 (54 %; P = 0.003), but there was no significant difference between groups H1 and H2. In the PACU, group H2 had a higher sedation score than groups H1 and H0 (P < 0.001).

Conclusions: For high-risk PONV patients undergoing gynecological laparoscopic surgery, when used with dexamethasone, 1-mg haloperidol was equally effective as 2 mg in terms of preventing PONV with the less sedative effect.

Trial registration: ClinicalTrials.gov ( NCT01639599 ).

No MeSH data available.


Related in: MedlinePlus