Characterization of the Use of Antiemetics in the Postoperative Period in Adult Patients Undergoing Surgery during January to May 2009 in a private hospital, Clínica Bíblica, in Costa Rica

Aim: To evaluate and characterize the pharmacotherapeutic approach with antiemetics during the postoperative, in adult patients undergoing surgery at the Hospital Clínica Bíblica (a private hospital in Costa Rica). Methods: Patients (with ages between 18 and 75), who underwent surgery and received some kind of prophylactic antiemetic before the procedure, were selected. Patients that had hospitalization periods shorter than 24 hours were excluded. Results: Prophylactic antiemetic therapy utilized in this hospital includes: granisetron, metoclopramide, dexamethasone, and dimenhydrinate. Granisetron, either alone or combined, was the most used antiemetic in 81% of the cases. The most commonly used combination was dexamethasone and granisetron in 57% of the cases. Without considering the surgical procedure, the incidence of postoperative nausea and vomiting (PONV) was 12% in patients taking granisetron, 25% with metoclopramide, 9% with dimenhydrinate, 13% with dexamethasone and 14% with other antiemetics. The surgeries with the greater incidence of PONV were orthopaedic surgery, 30%, and laparoscopic surgery, 28%. Finally, in cases in which fentanyl was used as an anesthetic, 18% of the patients presented PONV, whereas in patients cases were fentanyl was not used, the rate was 9%. Conclusion: Despite the widespread use of prophylactic antiemetics, PONV still occurs in patients at this private hospital. In spite of the wealth of knowledge in this field, physicians have not yet found an algorithm capable of the total prevention of PONV. Each patient’s individual risk and satisfaction should be taken into account. Further research on this matter must continue in order to unify and improve criteria for PONV treatment.