Title: Ondansetron Versus Droperidol for Postoperative Nausea and Vomiting
Abstract:In Response: We thank Dr. Phillips for his interest in our manuscript. The article referenced by Dr. Phillips is a meta-analysis of 53 clinical trials that sought the optimal dose of ondansetron based...In Response: We thank Dr. Phillips for his interest in our manuscript. The article referenced by Dr. Phillips is a meta-analysis of 53 clinical trials that sought the optimal dose of ondansetron based on the outcome variable of presence or absence of postoperative vomiting [1]. Meta-analyses, however, may have there their own set of problems, as noted in the accompanying editorial by Fisher [2]. Among these are the possibility of publication bias, the use of data that have not been collected uniformly, and the dependence on outcome measures that are universal to all the studies. As pointed out by Fisher, the only outcome noted by Tramer et al. [1] was the presence or absence of postoperative nausea and vomiting (PONV). Outcomes such as unplanned hospital admissions and patient satisfaction were not included. A more recent article by Dershwitz et al. [3] reported a dose-response study of 175 women undergoing elective surgery and specifically studied patient satisfaction, as well as the presence of PONV. The results of this study led the authors to conclude that 4 mg of ondansetron remained the recommended dose for PONV prophylaxis and that there was no advantage to larger doses. Interestingly, the article by Tramer et al. [1] also suggested that, when used on a dose/weight basis, further efficacy was not evident when the ondansetron dose was >50 [micro sign]g/kg (approximately 4 mg in an average 75-kg person). We believe that ondansetron 4 mg was the appropriate dose to use in the comparison with droperidol for the prevention of PONV. Jennifer T. Fortney, MD Tong Joo Gan, MD, MBBS, FRCA Peter S. A. Glass, MD Department of Anesthesiology; Duke University Medical Center; Durham, NC 27710Read More