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Au E, Zhao K, Belley-Côté E, Song Y, Al-Hazzani W, Sadeghirad B, Wang E, Young J, Kashani H, Kavosh M, Inami T, Beaver C, Kloppenburg S, Mazer D, Jacobsohn E, Um K, Spence J. The effect of perioperative benzodiazepine administration on postoperative nausea and vomiting: a systematic review and meta-analysis of randomised controlled trials. Br J Anaesth 2024; 132:469-482. [PMID: 38177006 DOI: 10.1016/j.bja.2023.11.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/30/2023] [Accepted: 11/07/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Despite recent systematic reviews suggesting their benefit for postoperative nausea, vomiting, or both (PONV) prevention, benzodiazepines have not been incorporated into guidelines for PONV prophylaxis because of concerns about possible adverse effects. We conducted an updated meta-analysis to inform future practice guidelines. METHODS We included randomised controlled trials (RCTs) of all languages comparing benzodiazepines with non-benzodiazepine comparators in adults undergoing inpatient surgery. Our outcomes were postoperative nausea, vomiting, or both. We assessed risk of bias for RCTs using the Cochrane Risk of Bias tool. We pooled data using a random-effects model and assessed the quality of evidence for each outcome using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. RESULTS We screened 31 413 abstracts and 950 full texts. We included 119 RCTs; 104 were included in quantitative synthesis. Based on moderate certainty evidence, we found that perioperative benzodiazepine administration reduced the incidence of PONV (52 studies, n=5086, relative risk [RR]: 0.77, 95% confidence interval [CI] 0.66-0.89; number needed to treat [NNT] 16; moderate certainty), postoperative nausea (55 studies, n=5916, RR: 0.72, 95% CI 0.62-0.83; NNT 21; moderate certainty), and postoperative vomiting (52 studies, n=5909, RR: 0.74, 95% CI 0.60-0.91; NNT 55; moderate certainty). CONCLUSIONS Moderate quality evidence shows that perioperative benzodiazepine administration decreases the incidence of PONV. The results of this systematic review and meta-analysis will inform future clinical practice guidelines. SYSTEMATIC REVIEW PROTOCOL The protocol for this systematic review was pre-registered with PROSPERO International Prospective Register of Systematic Reviews (CRD42022361088) and published in BMJ Open (PMID 31831540).
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Affiliation(s)
- Emily Au
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Karen Zhao
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Emilie Belley-Côté
- Department of Medicine (Cardiology and Critical Care), Perioperative Research Division, Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Yuri Song
- Faculty of Science, McMaster University, Hamilton, ON, Canada
| | - Waleed Al-Hazzani
- Departments of Critical Care, Medicine (Gastroenterology), Health Research Methods, Evaluation, and Impact (HEI), McMaster University, Hamilton, ON, Canada
| | - Behnam Sadeghirad
- Departments of Anesthesia and Health Research Methods, Evaluation, and Impact, McMaster University, Hamilton, ON, Canada
| | - Eugene Wang
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Jack Young
- Health Sciences Library, McMaster University, Hamilton, ON, Canada
| | - Hessam Kashani
- Department of Anesthesia and Perioperative Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Morvarid Kavosh
- Department of Medicine, Coney Island Hospital, New York, NY, USA
| | - Toru Inami
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | | | | | - David Mazer
- Department of Anesthesia and Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Eric Jacobsohn
- Department of Anesthesia and Perioperative Medicine and Medicine (Critical Care), University of Manitoba, Winnipeg, MB, Canada
| | - Kevin Um
- Department of Medicine (Cardiology), McMaster University, Hamilton, ON, Canada
| | - Jessica Spence
- Departments of Anesthesia and Critical Care and Health Research Methods, Evaluation, and Impact, Perioperative Research Division, Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
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Kim WJ, Kang H, Shin HY, Baek CW, Jung YH, Woo YC, Kim JY, Koo GH. Ramosetron, midazolam, and combination of ramosetron and midazolam for prevention of postoperative nausea and vomiting: A prospective, randomized, double-blind study. J Int Med Res 2013; 41:1203-13. [DOI: 10.1177/0300060513485864] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To compare the efficacy of ramosetron, midazolam, and the combination of ramosetron and midazolam in the prevention of postoperative nausea and vomiting (PONV) in female patients undergoing thyroidectomy. Methods Patients were randomized to receive 0.3 mg ramosetron (Group R), 75 µg/kg midazolam (Group M) or 0.3 mg ramosetron combined with 75 µg/kg midazolam (Group RM) before the induction of anaesthesia. PONV, use of rescue antiemetics, pain severity and fentanyl consumption were assessed for 24 h after thyroidectomy. Results A total of 100 patients were enrolled; 94 patients completed the study. The severity of nausea was statistically significantly reduced at 0–2 h in Group RM compared with Groups R and M, and at 2–6 h in Group RM compared with Group M. The incidence of retching and vomiting was significantly lower at 0–2 h, 2–6 h, 6–12 h in Group RM than in Group M, and lower in Group R than Group M at 6–12 h. The requirement for rescue antiemetics was significantly lower at 0–2 h in group RM than in group M. Conclusion The combination therapy of ramosetron and midazolam provided superior antiemetic efficacy compared with midazolam single therapy, but did not show any significant additional benefits compared with ramosetron single therapy.
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Affiliation(s)
- Won Joong Kim
- Department of Anaesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Hyun Kang
- Department of Anaesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Hwa Yong Shin
- Department of Anaesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Chong Wha Baek
- Department of Anaesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Yong Hun Jung
- Department of Anaesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Young Cheol Woo
- Department of Anaesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Jin Yun Kim
- Department of Anaesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Gil Hoi Koo
- Department of Anaesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
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Kim DS, Koo GH, Kang H, Baek CW, Jung YH, Woo YC, Kim JY, Park SG. The antiemetic effect of midazolam or/and ondansetron added to intravenous patient controlled analgesia in patients of pelviscopic surgery. Korean J Anesthesiol 2012; 62:343-9. [PMID: 22558501 PMCID: PMC3337381 DOI: 10.4097/kjae.2012.62.4.343] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Revised: 09/01/2011] [Accepted: 09/09/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We made a comparative study on the antiemetic effect of midazolam and ondansetron added to intravenous patient-controlled analgesia (PCA) using fentanyl with gynecologic patients undergoing pelviscopic surgery. METHODS The PCA using 20 µg/kg of fentanyl was started in all groups postoperatively. A dose of 16 mg of ondansetron was added to the PCA of group O (n = 30). A dose of 5 mg of midazolam was added to the PCA of group M (n = 30). While 16 mg of ondansetron and 5 mg of midazolam were added to the PCA of group MO (n = 30). Total volume of the PCA was 60 ml, and the PCA system was programmed to deliver 0.5 ml/h of continuous doses and a 0.5 ml bolus on demand, with a 15 minutes lockout interval. The incidence of postoperative nausea and vomiting (PONV), sedation score, visual analog scale (VAS) for pain, and rescue drug dose for PONV were investigated at the postanesthesia care unit (PACU), 6 hours, and 24 hours after recovery. RESULTS The incidence of PONV in group MO was significantly lower than in group O at PACU, 24 hours after recovery (P < 0.05). The sedation score and VAS pain score showed no differences among all groups. CONCLUSIONS Midazolam added to PCA using fentanyl proved more effective than ondansetron in preventing PONV without adverse effects.
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Affiliation(s)
- Dae Seong Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, Seoul, Korea
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