STUDY OBJECTIVE: To characterize the evolution of postoperative nausea and vomiting (PONV) prophylactic drug use. DESIGN: Retrospective data extraction and analysis of electronic anesthesia records. SETTING: Anesthesia department of an urban academic medical center. MEASUREMENTS: 144,134 anesthetics given by 57 attending anesthesiologists were studied. Administered doses of droperidol, ondansetron, dexamethasone, and metoclopramide were tabulated for each year for each practitioner. MAIN RESULTS: Ondansetron use in the periods before and after the Food and Drug Administration (FDA) warning concerning droperidol was 8% and 35%, respectively. Use of PONV prophylaxis increased for all included patient and anesthetic factors. Among those who used droperidol before the revised FDA warning, 61% stopped using it altogether. Afterwards, 75% (27-100%) of droperidol use was in combination with another agent. CONCLUSIONS: We found a significant and sustained decrease in droperidol use after the FDA-mandated labeling revision. We also found a significant increase in ondansetron use--an increase that exceeded the amount needed to substitute for the decreased droperidol use. The changes may be related to multiple factors, including the FDA warning, a trend toward more PONV prophylaxis, and the increasing predominance of serotonin antagonists for this indication.
STUDY OBJECTIVE: To characterize the evolution of postoperative nausea and vomiting (PONV) prophylactic drug use. DESIGN: Retrospective data extraction and analysis of electronic anesthesia records. SETTING: Anesthesia department of an urban academic medical center. MEASUREMENTS: 144,134 anesthetics given by 57 attending anesthesiologists were studied. Administered doses of droperidol, ondansetron, dexamethasone, and metoclopramide were tabulated for each year for each practitioner. MAIN RESULTS:Ondansetron use in the periods before and after the Food and Drug Administration (FDA) warning concerning droperidol was 8% and 35%, respectively. Use of PONV prophylaxis increased for all included patient and anesthetic factors. Among those who used droperidol before the revised FDA warning, 61% stopped using it altogether. Afterwards, 75% (27-100%) of droperidol use was in combination with another agent. CONCLUSIONS: We found a significant and sustained decrease in droperidol use after the FDA-mandated labeling revision. We also found a significant increase in ondansetron use--an increase that exceeded the amount needed to substitute for the decreased droperidol use. The changes may be related to multiple factors, including the FDA warning, a trend toward more PONV prophylaxis, and the increasing predominance of serotonin antagonists for this indication.
Authors: Stacie B Dusetzina; Ashley S Higashi; E Ray Dorsey; Rena Conti; Haiden A Huskamp; Shu Zhu; Craig F Garfield; G Caleb Alexander Journal: Med Care Date: 2012-06 Impact factor: 2.983