British Journal of Anaesthesia, Vol 82, Issue 3 379-386, Copyright © 1999 by The Board of Management and Trustees of the British Journal of Anaesthesia
M. R. Tramer and T. Fuchs-Buder
We have estimated the effect of omitting antagonism of neuromuscular block
on postoperative nausea and vomiting. A systematic search (MEDLINE, EMBASE,
Biological Abstracts, Cochrane library, reference lists and hand searching;
no language restriction, up to March 1998) was performed for relevant
randomized controlled trials. In eight studies (1134 patients), antagonism
with neostigmine or edrophonium was compared with spontaneous recovery
after general anesthesia with pancuronium, vecuronium, mivacurium or
tubocurarine. On combining neostigmine data, there was no evidence of an
antiemetic effect when it was omitted. However, the highest incidence of
emesis with neostigmine 1.5 mg was lower than the lowest incidence of
emesis with 2.5 mg. Numbers-needed-to-treat to prevent emesis by omitting
neostigmine compared with using it were consistently negative with 1.5 mg,
and consistently positive (3-6) with 2.5 mg. There was a lack of evidence
for edrophonium. In two studies, three patients with spontaneous recovery
after mivacurium or vecuronium needed rescue anticholinesterase drugs
because of clinically relevant muscle weakness (number-needed-to-harm, 30).
Omitting neostigmine may have a clinically relevant antiemetic effect when
high doses are used. Omitting antagonism, however, introduces a
non-negligent risk of residual paralysis even with short-acting
neuromuscular blocking agents.
CLINICAL INVESTIGATIONS
Omitting antagonism of neuromuscular block: effect on postoperative nausea and vomiting and risk of residual paralysis. A systematic review
Divison of Anaesthesiology, Department APSIC, Geneva University Hospital, CH-1211 Geneva 14, Switzerland; Department of Anaesthesiology, University of Saarland, D-66421 Homburg/Saar, Germany
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