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Haloperidol As Prophylactic Treatment for Postoperative

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Haloperidol As Prophylactic Treatment for Postoperative Document downloaded from http://http://www.revcolanest.com.co, day 15/02/2013. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. r e v c o l o m b a n e s t e s i o l . 2 0 1 3;4 1(1):34–43 Revista Colombiana de Anestesiología Colombian Journal of Anesthesiology www.revcolanest.com.co Review Haloperidol as prophylactic treatment for postoperative ଝ nausea and vomiting: Systematic literature review ∗ Catalina Chaparro , Diego Moreno, Verónica Ramírez, Angélica Fajardo, David González, Alejandra Sanín, Reinaldo Grueso Anesthesiology Service, Hospital Universitario San Ignacio, Bogotá, Colombia a r t i c l e i n f o a b s t r a c t Article history: Introduction: The effectiveness of haloperidol for the prophylaxis of postoperative nausea Received 3 July 2012 and vomiting (PONV) has been proven in prior trials summarized by Buttner in 2004. New Accepted 24 July 2012 evidence has surfaced since then. Our objective is thus to update the current knowledge on the topic. A systematic review and a meta-analysis were performed, in order to determine the effectiveness and safety of the use of haloperidol as prophylaxis for PONV. Keywords: Methodology: The systematic search, the selection of relevant articles, the extraction of data, Haloperidol the critical analysis of the primary studies, the comparisons and analyses were all based on Vomiting the recommendations of the Cochrane Collaboration and using RevMan5 software. Nausea Results: Ten controlled clinical trials published between 1962 and 2010, that included 2,711 Clinical trials patients, met the selection criteria. As compared against droperidol (RR: 0.97; 95% CI: 0.52–1.79) and against ondansetron (RR: 1.24; 95% CI: 0.66–2.35), no differences were found in terms of effectiveness after 24 h. A protective effect against PONV associated with the use of haloperidol at varying doses, routes of administration and timing of administration was observed as compared with placebo. No significant increases in adverse events have been reported. Discussion: This systematic review supports the effectiveness of haloperidol as prophylactic treatment of PONV. No statistically significant differences were found as compared against ondansetron or droperidol. Conclusions: Haloperidol is an effective prophylactic drug for PONV. © 2012 Sociedad Colombiana de Anestesiología y Reanimación. Published by Elsevier España, S.L. All rights reserved. ଝ Please cite this article as: Chaparro C, et al. Haloperidol como profilaxis para náuseas y vómito postoperatorios: revisión sistemática de la literatura. Rev Colomb Anestesiol. 2013;41:34–43. ∗ Corresponding author at: Carrera 7 # 40-60, Bogotá, Colombia. E-mail address: [email protected] (C. Chaparro). 2256-2087/$ – see front matter © 2012 Sociedad Colombiana de Anestesiología y Reanimación. Published by Elsevier España, S.L. All rights reserved. Document downloaded from http://http://www.revcolanest.com.co, day 15/02/2013. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. r e v c o l o m b a n e s t e s i o l . 2 0 1 3;4 1(1):34–43 35 Haloperidol como profilaxis para náuseas y vómito postoperatorios: revisión sistemática de la literatura r e s u m e n Palabras clave: Introducción: La efectividad del haloperidol en la profilaxis para náuseas y vómito postopera- Haloperidol torios (NVPO) ha sido demostrada en estudios previos resumidos en 2004 por Buttner. Desde Vómitos entonces ha surgido nueva evidencia, por lo cual nuestro objetivo es actualizar el estado pre- Náusea sente del conocimiento en este tema. Se realizó una revisión sistemática y metaanálisis con Ensayo clínico el fin de aproximarnos a la efectividad y a la seguridad del uso de haloperidol en la profilaxis de NVPO. Metodología: La búsqueda sistemática, la selección de artículos relevantes, la extracción de datos, el análisis crítico de los estudios primarios, las comparaciones y los análisis se realizaron con base en las recomendaciones de Cochrane Collaboration y a través del software RevMan5. Resultados: Diez experimentos clínicos controlados, publicados entre 1962 y 2010, que incluyen 2.711 pacientes, cumplen los criterios de selección. Comparado con el droperidol (RR: 0,97; IC 95%: 0,52-1,79) y con el ondansetrón (RR: 1,24; IC 95%: 0,66-2,35), no se encon- traron diferencias en la efectividad a las 24 h. Se evidencia un efecto protector contra NVPO asociado al uso de haloperidol en diferentes dosis, vías de administración y momentos de administración al comparar frente a placebo. No hay reporte de aumento de efectos adversos de forma significativa. Discusión: La efectividad de haloperidol como profilaxis de NVPO queda sustentada por esta revisión sistemática sin que se logren identificar diferencias estadísticamente significativas cuando se compara con el ondansetrón o el droperidol. Conclusiones: El haloperidol es un medicamento efectivo y seguro para la profilaxis de NVPO. © 2012 Sociedad Colombiana de Anestesiología y Reanimación. Publicado por Elsevier España, S.L. Todos los derechos reservados. 7 A meta-analysis published by Buttner et al. in 2004 evalu- Introduction ated the effectiveness of haloperidol under varying scenarios, including PONV, showing adequate effectiveness with no rela- Postoperative nausea and vomiting (PONV) are a frequent tionship between the dose used and the scope of the effect. problem associated with the administration of anesthesia 13,14 Since then, new evidence has been found evaluating and sedation resulting in patient dissatisfaction, delayed 15–21 haloperidol’s effectiveness and so we considered it appro- 1 discharge and unplanned admissions. Other complications priate to undertake a new systematic review to assess the described include surgical wound dehiscence and hematoma, effectiveness and safety of haloperidol as a prophylactic agent hydro-electrolytic imbalance, bronchoaspiration of gastric in PONV. 2,3 contents and esophageal rupture. Some of the risk factors independently related to PONV are: gender, non-use of tobacco, a history of PONV and the Objectives 4,5 administration of opiates during the perioperative period. The frequency of these complications varies, depending Main objective on the type and duration of surgery, the type of anes- thesia, anesthetic drugs and management of postoperative • To estimate the effectiveness of haloperidol for the prophy- pain.6 laxis of PONV in adults undergoing surgery, diagnostic or Haloperidol is an antagonist of the D2 dopaminergic therapeutic procedures under general or regional anesthe- receptors used in psychiatry and in the medical – surgical sia or under monitored anesthetic care. 7 management of delirium for over 40 years. It belongs to the group of butyrophenones which are potent antiemetic as is droperidol, one of the most commonly used and cost-effective Specific objectives medicines for the management of PONV, prior to the warning • issued by the Food and Drug Administration in 2003, regarding To estimate the frequency of adverse effects associated with 8–10 its relationship to the development of cardiac arrhythmia. the administration of haloperidol. • There is now a renewed interest in the use of haloperidol Estimate the need for therapeutic antiemetic agents fol- for the management of PONV, because it is an effective, safe lowing the prophylactic administration of haloperidol for and low cost alternative, with theoretical advantages such PONV. • as an extended half-life with a delayed potential protective To assess whether the risk of PONV changes depending on 11,12 effect. the route of administration of haloperidol. Document downloaded from http://http://www.revcolanest.com.co, day 15/02/2013. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. 36 r e v c o l o m b a n e s t e s i o l . 2 0 1 3;4 1(1):34–43 • To evaluate whether the risk of PONV changes depending to 7. MeSH-ANESTHESIA OR ANAESTHESIA OR ANESTHET* OR the time of administration of haloperidol. ANAESTHET* • To evaluate whether the risk of PONV changes according to 8. MeSH-HALOPERIDOL the dose of haloperidol administered. Filter: (randomized controlled trial [Publication Type] OR (randomized[Title/Abstract AND controlled[Title/ Materials and methods Abstract]AND trial[Title/Abstract]). A search of the unpublished literature was accomplished by Design contacting the most representative authors and the haloperi- dol pharmaceutical manufacturers. The search was done on Systematic literature review and met-analysis of clinical trials. the references of the selected articles, PONV clinical practice guidelines, editorials and relevant review articles. Inclusion criteria Tw o independent researches carried out the search and any discrepancies were settled by consensus. • Type of studies: Randomized clinical trials, both published and unpublished, evaluating the effectiveness of haloperi- Selection of trials dol in the prevention of PONV. • Type of participants: Adult patients undergoing diagnostic The titles of the articles found in the search were reviewed or therapeutic procedures under general/regional anesthe- to identify any relevant articles. Then a selection by abstract sia or sedation. was done, and an attempt was made to get the full text of the • Types of interventions: Haloperidol, at any dose or route selected article. The inclusion and exclusion criteria by two of administration, any moment prior to the occurrence of independent authors were used and any conflicts were settled PONV versus placebo, another drug or no treatment. The by consensus. drug could be administered in the preoperative period, dur- ing the induction of anesthesia, in the intraoperative or Data extraction postoperative period (prior to the occurrence of nausea and/or vomiting). • Tw o independent researchers reviewed the selected articles Types of outcomes: Incidence of nausea, vomiting, PONV, in order to extract the information about the participants, rescue remedies requirement, Q-T segment disorders and the interventions and outcomes. Any differences were agreed any haloperidol-related adverse effect.
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