Prophylactic Ondansetron in Post-op Cardiac Surgery Patients to Prevent Post-operative Nausea and Vomiting

Postoperative Nausea and Vomiting Clinical Trial

Official title:

A Double-blinded, Randomized Control Trial of Prophylactic Ondansetron in a Post-operative Cardiac Surgery Population for Post-operative Nausea and Vomiting

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT02966041
• Other study ID #: H15-00675
• Status: Completed
• Phase: N/A
• Start date: March 6, 2018
• Est. completion date: July 11, 2018

Study information

• Verified date: October 2018
• Source: University of British Columbia
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

To evaluate the effectiveness of a prophylactic dose of ondansetron in decreasing the incidence of post-operative nausea and vomiting in cardiac surgery patients after cessation of post-operative sedation. In patients who have undergone open heart surgery, a single prophylactic dose of ondansetron 4 mg IV given at the time of discontinuing propofol sedation will result in a 50% reduction of the rate of post-operative nausea and vomiting in the first 24 post-operative hours compared to placebo.

Description:

Post-operative nausea and vomiting (PONV) is a significant source of morbidity for patients undergoing general anesthesia, and in particular, patients undergoing cardiac anesthesia. Despite its common occurrence, literature on PONV prophylaxis in the cardiac surgical population is limited relative to other surgical populations.

A rational approach to preventing PONV would be to administer prophylaxis prior to extubation once post-operative sedation has ceased. This timing of administration would be more standardized across patients, as duration of surgery and time of extubation after surgery can vary considerably, rendering plasma levels of PONV prophylaxis agents highly variable across patients.

At St. Paul's Hospital, PONV prophylaxis has not been a routine part of cardiac anesthesia care. Furthermore, there are no standardized guidelines, and practice varies between care providers. Following surgery, patients recover from anesthesia and are extubated in the cardiac surgery ICU (CSICU). They are usually sedated on a propofol infusion for one to four hours after surgery until they are ready for extubation. When PONV occurs, the first line drug for treatment is ondansetron 4 mg. The investigators therefore propose the use of a single, prophylactic dose of ondansetron (4 mg IV), given at the time of propofol cessation. A randomized, double blinded placebo controlled model will be utilized

Recruitment information / eligibility

• Status: Completed
• Enrollment: 186
• Est. completion date: July 11, 2018
• Est. primary completion date: July 11, 2018
• Accepts healthy volunteers: No
• Gender: All
• Age group: 19 Years and older

Eligibility

Inclusion Criteria:

• Elective (outpatient) and urgent (inpatient) cardiac surgery procedures requiring cardiopulmonary bypass, including:

• Coronary artery bypass grafting (CABG)

• Valve surgery (ie. repair and/or replacement)

• CABG and valve surgery

Exclusion Criteria:

• Undergoing 'off-pump' CABG (not involving the cardiopulmonary bypass machine)

• With a contraindication to the study drug - including but not limited to congenital Long QT Syndrome, allergy to ondansetron, or a history of migraines

• Unable to understand the consent process, either due to language limitations or cognitive limitations if a translator or substitute decision maker is not available

• Receiving heart transplants, ventricular assist devices or on extra-corporeal membrane oxygenation (ECMO)

• Intubated for more than 12 hours post-operatively

• With a known history of PONV

• Sedated with dexmedatomine instead of propofol

Related Conditions & MeSH terms

• Nausea
• Postoperative Nausea and Vomiting
• Vomiting

Intervention

Drug:
• Ondansetron
Ondansetron/Zofran is an antiemetic drug used to prevent and treat nausea and vomiting.
• Saline
Normal saline is salt water and is acting as a placebo in this study. A placebo is an inactive substance that looks identical to the test drug, but it contains no therapeutic ingredient.

Locations

Country	Name	City	State
Canada	St. Paul's Hospital	Vancouver	British Columbia

Sponsors (1)

Lead Sponsor	Collaborator
University of British Columbia

Country where clinical trial is conducted

Canada, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Occurrence of Post-operative Nausea and Vomiting (PONV)	Measured by asking the patient hourly to assess their post operative nausea and vomiting using a 10-point verbal Likert rating scale.	First 24 hours post-extubation
Secondary	Incidence of Rescue PONV medication administration	How many participants received rescue post-operative nausea and vomiting medication post-extubation after surgery.	First 24 hours post-extubation
Secondary	Time to first dose of rescue PONV medication	Time of administration of first dose of rescue post-operative nausea and vomiting medication	First 24 hours post-extubation
Secondary	Dose of any Rescue PONV medication	Dose of administered rescue post-operative nausea and vomiting medication after extubation.	First 24 hours post-extubation
Secondary	Time to first report of nausea or first vomit post-operatively	Time to first report of any nausea or vomiting after extubation post-operatively.	First 24 hours post-extubation
Secondary	Incidence of Post-operative nausea without vomiting	Nurses both asked patients' for a nausea severity rating and recorded any vomiting hourly.	First 24 hours post-extubation
Secondary	Severity Post-operative nausea without vomiting	Severity of post-operative nausea without vomiting based on a 10-point likert scale, recorded hourly.	First 24 hours post-extubation
Secondary	Incidence of ventricular arrhythmias	Any sustained Ventricular Arrhythmias (i.e. lasting greater than 30 seconds)	first 24 hours post-extubation