Tropisetron in the prevention of postoperative nausea and vomiting

Study Objectives: To evaluate the efficacy of tropisetron, a selective 5-HT3 receptor antagonist, in preventing nausea and vomiting in highrisk inpatients undergoing various surgical procedures. Design: Prospective, open, nonrandomized, observational, interventional study. Setting: Postanesthesia care unit, and surgical wards of the University Hospital Center, Charleroi. Patients: A total of 1,132 elective surgical inpatients (> 15 years of age) in two separate surveys. The first prospective survey covered all surgical adult inpatients (n = 671) after various surgical procedures over a 3-month period. A new 3-month survey was performed to assess the effectiveness of the preventive measure and included another 461 patients. Interventions: Risk factors associated with nausea and vomiting were recorded in the first survey and used to establish an antiemetic policy. This consisted in the administration of tropisetron 2 mg intravenously after anesthesia induction, if two patient-related risk factors associated with high-risk surgery and general anesthesia were present. Measurements and Main Results: Nausea frequency and intensity, assessed every 4 hours using a visual analog scale (VAS) frequency and times of vomiting episodes and the need for rescue medication were recorded for 72 hours postoperatively. Nausea was experienced by 18.8% and vomiting by 9.8% of the patients in the first survey (211 high risk-patients of 671). In the second survey, 137 patients of 461, considered at high-risk received prophylactic tropisetron. The proportion of patients having nausea decreased to 11.1% (p,178 0.01) and vomiting episodes to 2.8% (p < 0.001). Twenty-six of the tropisetron-treated patients (19%) suffered subsequent postoperative nausea and vomiting (PONV). Patient satisfaction with tropisetron was high. Conclusion: Prophylactic tropisetron can reduce the incidence of PONV in selected high-risk inpatients undergoing various types of surgical procedures. (C) 2000 by Elsevier Science Inc.