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ANESTHETIC PHARMACOLOGY

Ondansetron is no More Effective than Supplemental Intraoperative Oxygen for Prevention of Postoperative Nausea and Vomiting

Veronika Goll, MD^*, Ozan Akça, MD, Robert Greif, MD, Helga Freitag, MD^*, Cem F. Arkiliç, MD^§, Thomas Scheck, BS^*, Agnes Zoeggeler, MD^*, Andrea Kurz, MD^§, Gabriella Krieger, MD^*, Rainer Lenhardt, MD^*, and Daniel I. Sessler, MD^||

*Department of Anesthesia and General Intensive Care, University of Vienna, Vienna, Austria; the Outcomes Research^TM Institute and Department of Anesthesiology, University of Louisville, Kentucky; Department of Anesthesiology and Intensive Care Medicine, Donauspital—SMZO, Vienna, Austria; §Department of Anesthesiology, Washington University, St. Louis, MO; and ||the Ludwig Boltzmann Institute, Vienna, Austria

Address correspondence to Daniel I. Sessler, MD, University of Louisville, Abell Administration Center, Room 217, 323 East Chestnut Street, Louisville, KY 40202-3866. Address e-mail to sessler{at}louisville.edu

Supplemental oxygen maintained during and for 2 h after colon resection halves the incidence of nausea and vomiting. Whether supplemental oxygen restricted to the intraoperative period is sufficient remains unknown. Similarly, the relative efficacy of supplemental oxygen and ondansetron is unknown. We tested the hypothesis that intraoperative supplemental oxygen reduces the incidence of postoperative nausea and vomiting. Patients (n = 240) undergoing gynecological laparoscopy were given a standardized isoflurane anesthetic. After induction, they were randomly assigned to the following three groups: routine oxygen administration with 30% oxygen, balance nitrogen (30% Oxygen group), supplemental oxygen administration with 80% oxygen, balance nitrogen (80% Oxygen group), and Ondansetron 8 mg (immediately after induction), combined with 30% oxygen, balance nitrogen (Ondansetron group). The overall incidence of nausea and/or vomiting during the initial 24 postoperative h was 44% in the patients assigned to 30% oxygen and 30% in the Ondansetron group, but only 22% in those given 80% oxygen. The incidence was thus halved by supplemental oxygen and was significantly less than with 30% oxygen. There were, however, no significant differences between the 30% oxygen and ondansetron groups, or between the ondansetron and 80% oxygen groups. We conclude that supplemental oxygen effectively prevents postoperative nausea and vomiting after gynecological laparoscopic surgery; furthermore, ondansetron is no more effective than supplemental oxygen.

Implications: Supplemental oxygen reduces the risk of postoperative nausea and vomiting (PONV) as well or better than 8 mg of ondansetron. Because oxygen is inexpensive and essentially risk-free, supplemental oxygen is a preferable method of reducing PONV.

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