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Neurokinin-1 receptor antagonists for postoperative nausea and vomiting: a systematic review and meta-analysis
BACKGROUND: Postoperative Nausea and Vomiting (PONV) is a common complication of general anesthesia. Several kinds of antiemetics, including 5-Hydroxytryptamine3 (5-HT3) receptor antagonists, and Neurokinin-1 (NK-1) receptor antagonists have been used to treat PONV. OBJECTIVES: To compare the antiem...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9373091/ https://www.ncbi.nlm.nih.gov/pubmed/32753114 http://dx.doi.org/10.1016/j.bjane.2020.06.015 |
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author | Murakami, Chiaki Kakuta, Nami Satomi, Shiho Nakamura, Ryuji Miyoshi, Hirotsugu Morio, Atsushi Saeki, Noboru Kato, Takahiro Ohshita, Naohiro Tanaka, Katsuya Tsutsumi, Yasuo M. |
author_facet | Murakami, Chiaki Kakuta, Nami Satomi, Shiho Nakamura, Ryuji Miyoshi, Hirotsugu Morio, Atsushi Saeki, Noboru Kato, Takahiro Ohshita, Naohiro Tanaka, Katsuya Tsutsumi, Yasuo M. |
author_sort | Murakami, Chiaki |
collection | PubMed |
description | BACKGROUND: Postoperative Nausea and Vomiting (PONV) is a common complication of general anesthesia. Several kinds of antiemetics, including 5-Hydroxytryptamine3 (5-HT3) receptor antagonists, and Neurokinin-1 (NK-1) receptor antagonists have been used to treat PONV. OBJECTIVES: To compare the antiemetic effect of NK-1 receptor antagonists, including fosaprepitant. DATA SOURCES: Online databases (PubMed, MEDLINE, Scopus, The Cochrane Library databases) were used. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS: Randomized Controlled Trials (RCTs) performed in patients over 18 years with ASA-PS of I‒III, aimed to assess the efficacy of antiemetics including NK-1 receptor antagonists and 5-HT3 receptor antagonists, and compared the incidence of PONV were included. STUDY APPRAISAL AND SYNTHESIS METHODS: All statistical assessments were conducted by a random effect approach, and odds ratios and 95% Confidence Intervals were calculated. RESULTS: Aprepitant 40 mg and 80 mg significantly reduced the incidence of vomiting 0‒24 hours postoperatively (Odds Ratio [OR = 0.40]; 95% Confidence Interval [95% CI 0.30‒0.54]; p < 0.001, and OR = 0.32; 95% CI 0.19‒0.56; p < 0.001). Fosaprepitant could also reduce the incidence of vomiting significantly both 0‒24 and 0‒48 hours postoperatively (OR = 0.07; 95% CI 0.02‒0.24; p < 0.001 and OR = 0.07; 95% CI 0.02‒0.23; p < 0.001). LIMITATIONS: Risk factors for PONV are not considered, RCTs using multiple antiemetics are included, RCTs for fosaprepitant is small, and some bias may be present. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: Aprepitant and fosaprepitant can be effective prophylactic antiemetics for postoperative vomiting. However, more studies are required for higher-quality meta-analyses. SYSTEMATIC REVIEW REGISTRATION NUMBER: CRD42019120188. |
format | Online Article Text |
id | pubmed-9373091 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-93730912022-08-15 Neurokinin-1 receptor antagonists for postoperative nausea and vomiting: a systematic review and meta-analysis Murakami, Chiaki Kakuta, Nami Satomi, Shiho Nakamura, Ryuji Miyoshi, Hirotsugu Morio, Atsushi Saeki, Noboru Kato, Takahiro Ohshita, Naohiro Tanaka, Katsuya Tsutsumi, Yasuo M. Braz J Anesthesiol Systematic Review BACKGROUND: Postoperative Nausea and Vomiting (PONV) is a common complication of general anesthesia. Several kinds of antiemetics, including 5-Hydroxytryptamine3 (5-HT3) receptor antagonists, and Neurokinin-1 (NK-1) receptor antagonists have been used to treat PONV. OBJECTIVES: To compare the antiemetic effect of NK-1 receptor antagonists, including fosaprepitant. DATA SOURCES: Online databases (PubMed, MEDLINE, Scopus, The Cochrane Library databases) were used. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS: Randomized Controlled Trials (RCTs) performed in patients over 18 years with ASA-PS of I‒III, aimed to assess the efficacy of antiemetics including NK-1 receptor antagonists and 5-HT3 receptor antagonists, and compared the incidence of PONV were included. STUDY APPRAISAL AND SYNTHESIS METHODS: All statistical assessments were conducted by a random effect approach, and odds ratios and 95% Confidence Intervals were calculated. RESULTS: Aprepitant 40 mg and 80 mg significantly reduced the incidence of vomiting 0‒24 hours postoperatively (Odds Ratio [OR = 0.40]; 95% Confidence Interval [95% CI 0.30‒0.54]; p < 0.001, and OR = 0.32; 95% CI 0.19‒0.56; p < 0.001). Fosaprepitant could also reduce the incidence of vomiting significantly both 0‒24 and 0‒48 hours postoperatively (OR = 0.07; 95% CI 0.02‒0.24; p < 0.001 and OR = 0.07; 95% CI 0.02‒0.23; p < 0.001). LIMITATIONS: Risk factors for PONV are not considered, RCTs using multiple antiemetics are included, RCTs for fosaprepitant is small, and some bias may be present. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: Aprepitant and fosaprepitant can be effective prophylactic antiemetics for postoperative vomiting. However, more studies are required for higher-quality meta-analyses. SYSTEMATIC REVIEW REGISTRATION NUMBER: CRD42019120188. Elsevier 2020-06-25 /pmc/articles/PMC9373091/ /pubmed/32753114 http://dx.doi.org/10.1016/j.bjane.2020.06.015 Text en © 2020 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Systematic Review Murakami, Chiaki Kakuta, Nami Satomi, Shiho Nakamura, Ryuji Miyoshi, Hirotsugu Morio, Atsushi Saeki, Noboru Kato, Takahiro Ohshita, Naohiro Tanaka, Katsuya Tsutsumi, Yasuo M. Neurokinin-1 receptor antagonists for postoperative nausea and vomiting: a systematic review and meta-analysis |
title | Neurokinin-1 receptor antagonists for postoperative nausea and vomiting: a systematic review and meta-analysis |
title_full | Neurokinin-1 receptor antagonists for postoperative nausea and vomiting: a systematic review and meta-analysis |
title_fullStr | Neurokinin-1 receptor antagonists for postoperative nausea and vomiting: a systematic review and meta-analysis |
title_full_unstemmed | Neurokinin-1 receptor antagonists for postoperative nausea and vomiting: a systematic review and meta-analysis |
title_short | Neurokinin-1 receptor antagonists for postoperative nausea and vomiting: a systematic review and meta-analysis |
title_sort | neurokinin-1 receptor antagonists for postoperative nausea and vomiting: a systematic review and meta-analysis |
topic | Systematic Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9373091/ https://www.ncbi.nlm.nih.gov/pubmed/32753114 http://dx.doi.org/10.1016/j.bjane.2020.06.015 |
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