Skip to main content
SpringerLink
Log in

Übelkeit und Erbrechen in der postoperativen Phase

Experten- und evidenzbasierte Empfehlungen zu Prophylaxe und Therapie

Nausea and vomiting in the postoperative phase

Expert- and evidence-based recommendations for prophylaxis and therapy

  • Medizin aktuell
  • Published:
Der Anaesthesist Aims and scope Submit manuscript

Zusammenfassung

Bislang existieren für den deutschen Sprachraum keine expertenbasierten Handlungsempfehlungen zur Vermeidung oder Therapie von „postoperative nausea and vomiting“ (postoperative Übelkeit und Erbrechen, PONV). Ziel war daher die Entwicklung von Empfehlungen, aus denen im klinikspezifischen Kontext „standard operating procedures“ (SOPs) abgeleitet werden können. Ein anästhesiologisch besetztes Expertengremium bearbeitete relevante Schlüsselthemen in Arbeitsgruppen, die anschließend im Plenum diskutiert wurden. Die Empfehlungen sollten sich auf Erkenntnisse stützen, zu denen umfassende und vertrauenswürdige Daten vorliegen. Einzelne Risikofaktoren, wie z. B. die Anamnese des Patienten, besitzen, isoliert betrachtet, keine ausreichende Sensitivität und Spezifität, um anhand dessen klinisch rationale Entscheidungen zu treffen. Im Gegensatz dazu berücksichtigen vereinfachte Risikoscores mehrere Faktoren und ermöglichen folglich eine zuverlässigere Risikoeinschätzung. Einzelne antiemetische Interventionen zur Vermeidung von PONV sind mit einer relativen Risikoreduktion von ca. 30% im Allgemeinen vergleichbar effektiv. Dieses scheint für die total intravenöse Anästhesie (TIVA) ebenso wie für Dexamethason und andere Antiemetika (Dimenhydrinat, Droperidol, Serotoninantagonisten, transdermales Scopolamin) zu gelten. Eine adäquate, hinreichend hohe Dosierung ist dabei Voraussetzung, die bei Kindern natürlich gewichtsadaptiert erfolgen sollte. Während die relative Risikoreduktion weitgehend unabhängig vom Kontext ist, sind die absolute Risikoreduktion und somit die „number needed totreat“ (NNT) einer Prophylaxe vor allem vom Patientenrisiko abhängig. Bei einem niedrigen Risiko erscheint eine Prophylaxe nicht sinnvoll. Bei mittlerem Risiko sollte eine Prophylaxe nicht vorenthalten werden. Ein hohes Risiko erfordert ein multimodales Vorgehen, das im Einzelfall angepasst werden sollte (medizinisches Risiko, Patientenpräferenz). Die Therapie von PONV sollte prompt, vorzugsweise mit zuvor noch nicht verwendeten Antiemetika erfolgen. Das Gremium schlägt Algorithmen vor, bei denen die Indikation und das Ausmaß einer Prophylaxe vor allem vom Patientenrisiko abhängig sind. Unter Berücksichtigung lokaler Gegebenheiten sollten diese eine evidenzbasierte Erstellung von SOPs erleichtern.

Abstract

There are no consensus guidelines for the management of postoperative nausea and vomiting (PONV) in German speaking countries. This meeting was intended to develop such guidelines on which individual health care facilities can derive their specific standard operating procedures (SOPs). Anesthesiologists reviewed published literature on key topics which were subsequently discussed during two meetings. It was emphasized that recommendations were based on the best available evidence. The clinical relevance of individual risk factors should be viewed with caution since even well proven risk factors, such as the history of PONV, do not allow the identification of patients at risk for PONV with a satisfactory sensitivity or specificity. A more useful approach is the use of simplified risk scores which consider the presence of several risk factors simultaneously. Most individual antiemetic interventions for the prevention of PONV have comparable efficacy with a relative risk reduction of about 30%. This appears to be true for total intravenous anesthesia (TIVA) as well as for dexamethasone and other antiemetics; assuming a sufficiently high, adequate and equipotent dosage which should be weight-adjusted in children. As the relative risk reduction is context independent and similar between the interventions, the absolute risk reduction of prophylactic interventions is mainly dependent on the patient’s individual baseline risk. Prophylaxis is thus rarely warranted in patients at low risk, generally needed in patients with a moderate risk and should include a multimodal approach in patients at high risk for PONV. Therapeutic interventions of PONV should be administered promptly using an antiemetic which has not been used before. The group suggests algorithms where prophylactic interventions are mainly dependent on the patient’s risk for PONV. These algorithms should provide evidence-based guidelines allowing the development of SOPs/policies which take local circumstances into account.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3

Literatur

  1. Alon E, Buchser E, Herrera E et al. (1998) Tropisetron for treating established postoperative nausea and vomiting: a randomized, double-blind, placebo-controlled study. Anesth Analg 86: 617–623

    Article  PubMed  CAS  Google Scholar 

  2. Andrews PL (1992) Physiology of nausea and vomiting. Br J Anaesth 69: 2S–19S

    Article  PubMed  CAS  Google Scholar 

  3. Apfel CC, Bacher A, Biedler A et al. (2005) Eine faktorielle Studie von 6 Interventionen zur Vermeidung von Übelkeit und Erbrechen nach Narkosen: Ergebnisse des International Multicenter Protocol to assess the single and combined benefits of antiemetic strategies in a controlled clinical trial of a 2×2×2×2×2×2 factorial design (IMPACT). Anaesthesist 54: 201–209

    Article  PubMed  CAS  Google Scholar 

  4. Apfel CC, Greim CA, Goepfert C et al. (1998) Postoperatives Erbrechen. Ein Score zur Voraussage der Erbrechenswahrscheinlichkeit nach Inhalationsanaesthesien. Anaesthesist 47: 732–740

    Article  PubMed  CAS  Google Scholar 

  5. Apfel CC, Korttila K, Abdalla M et al. (2003) An international multicenter protocol to assess the single and combined benefits of antiemetic interventions in a controlled clinical trial of a 2×2x2×2x2×2 factorial design (IMPACT). Control Clin Trials 24: 736–751

    Article  PubMed  Google Scholar 

  6. Apfel CC, Korttila K, Abdalla M et al. (2004) A factorial trial of six interventions for the prevention of postoperative nausea and vomiting. N Engl J Med 350: 2441–2451

    Article  PubMed  CAS  Google Scholar 

  7. Apfel CC, Kranke P, Eberhart LH (2004) Comparison of surgical site and patient’s history with a simplified risk score for the prediction of postoperative nausea and vomiting. Anaesthesia 59: 1078–1082

    Article  PubMed  CAS  Google Scholar 

  8. Apfel CC, Kranke P, Eberhart LH et al. (2002) Comparison of predictive models for postoperative nausea and vomiting. Br J Anaesth 88: 234–240

    Article  PubMed  CAS  Google Scholar 

  9. Apfel CC, Kranke P, Greim CA, Roewer N (2001) What can be expected from risk scores for predicting postoperative nausea and vomiting? Br J Anaesth 86: 822–827

    Article  PubMed  CAS  Google Scholar 

  10. Apfel CC, Kranke P, Katz MH et al. (2002) Volatile anaesthetics may be the main cause of early but not delayed postoperative vomiting: a randomized controlled trial of factorial design. Br J Anaesth 88: 659–668

    Article  PubMed  CAS  Google Scholar 

  11. Apfel CC, Läärä E, Koivuranta M et al. (1999) A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Anesthesiology 91: 693–700

    Article  PubMed  CAS  Google Scholar 

  12. Apfel CC, Roewer N (2004) Postoperative Übelkeit und Erbrechen. Anaesthesist 53: 377–389

    Article  PubMed  CAS  Google Scholar 

  13. Büttner M, Walder B, Elm E von, Tramer MR (2004) Is low-dose haloperidol a useful antiemetic?: a meta-analysis of published and unpublished randomized trials. Anesthesiology 101: 1454–1463

    Article  PubMed  Google Scholar 

  14. Charbit B, Albaladejo P, Funck-Brentano C et al. (2005) Prolongation of QTc interval after postoperative nausea and vomiting treatment by droperidol or ondansetron. Anesthesiology 102: 1094–1100

    Article  PubMed  Google Scholar 

  15. Chen X, Tang J, White PF et al. (2001) The effect of timing of dolasetron administration on its efficacy as a prophylactic antiemetic in the ambulatory setting. Anesth Analg 93: 906–911

    Article  PubMed  CAS  Google Scholar 

  16. Cohen MM, Duncan PG, DeBoer DP, Tweed WA (1994) The postoperative interview: assessing risk factors for nausea and vomiting. Anesth Analg 78: 7–16

    Article  PubMed  CAS  Google Scholar 

  17. Du Pen S, Scuderi P, Wetchler B et al. (1992) Ondansetron in the treatment of postoperative nausea and vomiting in ambulatory outpatients: a dose-comparative, stratified, multicentre study. Eur J Anaesthesiol Suppl 6: 55–62

    Google Scholar 

  18. Eberhart L, Morin A, Geldner G, Wulf H (2003) Minimierung von Übelkeit und Erbrechen in der postoperativen Phase. Dtsch Arztebl 100: A2584–A2591

    Google Scholar 

  19. Eberhart LH, Geldner G, Kranke P et al. (2004) The development and validation of a risk score to predict the probability of postoperative vomiting in pediatric patients. Anesth Analg 99: 1630–1637; table

    Article  PubMed  CAS  Google Scholar 

  20. Eberhart LH, Hogel J, Seeling W et al. (2000) Evaluation of three risk scores to predict postoperative nausea and vomiting. Acta Anaesthesiol Scand 44: 480–488

    Article  PubMed  CAS  Google Scholar 

  21. Eberhart LH, Mauch M, Morin AM et al. (2002) Impact of a multimodal anti-emetic prophylaxis on patient satisfaction in high-risk patients for postoperative nausea and vomiting. Anaesthesia 57: 1022–1027

    Article  PubMed  CAS  Google Scholar 

  22. Eberhart LH, Morin AM, Bothner U, Georgieff M (2000) Droperidol and 5-HT3-receptor antagonists, alone or in combination, for prophylaxis of postoperative nausea and vomiting. A meta-analysis of randomised controlled trials. Acta Anaesthesiol Scand 44: 1252–1257

    Article  PubMed  CAS  Google Scholar 

  23. Eberhart LH, Morin AM, Georgieff M (2000) Dexamethason zur Prophylaxe von Übelkeit und Erbrechen in der postoperativen Phase – Eine Metaanalyse kontrollierter randomisierter Studien. Anaesthesist 49: 713–720

    Article  PubMed  CAS  Google Scholar 

  24. Eberhart LH, Morin AM, Guber D et al. (2004) Applicability of risk scores for postoperative nausea and vomiting in adults to paediatric patients. Br J Anaesth 93: 386–392

    Article  PubMed  CAS  Google Scholar 

  25. Eberhart LH, Seeling W, Staack AM, Georgieff M (1999) Validierung eines Risikoscores zur Vorhersage von Erbrechen in der postoperativen Phase. Anaesthesist 48: 607–612

    Article  PubMed  CAS  Google Scholar 

  26. Foster PN, Stickle BR, Laurence AS (1996) Akathisia following low-dose droperidol for antiemesis in day-case patients. Anaesthesia 51: 491–494

    Article  PubMed  CAS  Google Scholar 

  27. Gan TJ, Coop A, Philip BK (2005) A randomized, double-blind study of granisetron plus dexamethasone versus ondansetron plus dexamethasone to prevent postoperative nausea and vomiting in patients undergoing abdominal hysterectomy. Anesth Analg 101: 1323–1329

    Article  PubMed  CAS  Google Scholar 

  28. Gan TJ, Meyer T, Apfel CC et al. (2003) Consensus guidelines for managing postoperative nausea and vomiting. Anesth Analg 97: 62–71

    Article  PubMed  Google Scholar 

  29. Habib AS, Gan TJ (2003) Food and drug administration black box warning on the perioperative use of droperidol: a review of the cases. Anesth Analg 96: 1377–1379

    Article  PubMed  Google Scholar 

  30. Habib AS, Gan TJ (2005) The effectiveness of rescue antiemetics after failure of prophylaxis with ondansetron or droperidol: a preliminary report. J Clin Anesth 17: 62–65

    Article  PubMed  CAS  Google Scholar 

  31. Hechler A, Neumann S, Jehmlich M et al. (2001) A small dose of droperidol decreases postoperative nausea and vomiting in adults but cannot improve an already excellent patient satisfaction. Acta Anaesthesiol Scand 45: 501–506

    Article  PubMed  CAS  Google Scholar 

  32. Henzi I, Sonderegger J, Tramèr MR (2000) Efficacy, dose-response, and adverse effects of droperidol for prevention of postoperative nausea and vomiting. Can J Anaesth 47: 537–551

    PubMed  CAS  Google Scholar 

  33. Henzi I, Walder B, Tramèr MR (1999) Metoclopramide in the prevention of postoperative nausea and vomiting: a quantitative systematic review of randomized, placebo-controlled studies. Br J Anaesth 83: 761–771

    PubMed  CAS  Google Scholar 

  34. Henzi I, Walder B, Tramèr MR (2000) Dexamethasone for the prevention of postoperative nausea and vomiting: a quantitative systematic review. Anesth Analg 90: 186–194

    Article  PubMed  CAS  Google Scholar 

  35. Hill RP, Lubarsky DA, Phillips-Bute B et al. (2000) Cost-effectiveness of prophylactic antiemetic therapy with ondansetron, droperidol, or placebo. Anesthesiology 92: 958–967

    Article  PubMed  CAS  Google Scholar 

  36. Irefin SA, Farid IS, Senagore AJ (2000) Urgent colectomy in a patient with membranous tracheal disruption after severe vomiting. Anesth Analg 91: 1300–1302

    Article  PubMed  CAS  Google Scholar 

  37. Kazemi-Kjellberg F, Henzi I, Tramer MR (2001) Treatment of established postoperative nausea and vomiting: a quantitative systematic review. BMC Anesthesiol 1: 2

    Article  PubMed  Google Scholar 

  38. Khalil S, Rodarte A, Weldon BC et al. (1996) Intravenous ondansetron in established postoperative emesis in children. Anesthesiology 85: 270–276

    Article  PubMed  CAS  Google Scholar 

  39. Koivuranta M, Läärä E, Snare L, Alahuhta S (1997) A survey of postoperative nausea and vomiting. Anaesthesia 52: 443–449

    Article  PubMed  CAS  Google Scholar 

  40. Korttila K, Diemunsch P, Whitmore J, Hahne W (1997) Timing of administration of dolasetron affects dose necessary to prevent post-operative nausea and vomiting (PONV). Eur J Anaesthesiol 14: 83–84

    Google Scholar 

  41. Korttila KT, Jokinen JD (2004) Timing of administration of dolasetron affects dose necessary to prevent postoperative nausea and vomiting. J Clin Anesth 16: 364–370

    Article  PubMed  CAS  Google Scholar 

  42. Kovac AL, O’Connor TA, Pearman MH et al. (1999) Efficacy of repeat intravenous dosing of ondansetron in controlling postoperative nausea and vomiting: a randomized, double-blind, placebo-controlled multicenter trial. J Clin Anesth 11: 453–459

    Article  PubMed  CAS  Google Scholar 

  43. Kovac AL, Scuderi PE, Boerner TF et al. (1997) Treatment of postoperative nausea and vomiting with single intravenous doses of dolasetron mesylate: a multicenter trial. Dolasetron Mesylate PONV Treatment Study Group. Anesth Analg 85: 546–552

    Article  PubMed  CAS  Google Scholar 

  44. Kranke P, Apfel CC, Eberhart LH et al. (2001) The influence of a dominating centre on a quantitative systematic review of granisetron for preventing postoperative nausea and vomiting. Acta Anaesthesiol Scand 45: 659–670

    Article  PubMed  CAS  Google Scholar 

  45. Kranke P, Eberhart LH, Apfel CC et al. (2002) Tropisetron zur Prophylaxe von Übelkeit und Erbrechen in der postoperativen Phase. Eine quantitative systematische Übersicht. Anaesthesist 51: 805–814

    Article  PubMed  CAS  Google Scholar 

  46. Kranke P, Eberhart LHJ, Morin AM, Roewer N (2002) Dolasetron zur Prophylaxe von Übelkeit und Erbrechen nach Narkosen – Eine Metaanalyse kontrollierter randomisierter Studien. Anasthesiol Intensivmed 43: 413–427

    Google Scholar 

  47. Kranke P, Morin A, Vogel H et al. (2006) Clinical and economic efficiency of approaches to prevent PONV. Anesth Analg 102: 133

    Google Scholar 

  48. Kranke P, Morin AM, Roewer N, Eberhart LHJ (2002) Dimenhydrinate for prophylaxis of postoperative nausea and vomiting. A meta-analysis of randomised controlled trials. Acta Anaesthesiol Scand 46: 238–244

    Article  PubMed  CAS  Google Scholar 

  49. Kranke P, Morin AM, Roewer N et al. (2002) The efficacy and safety of transdermal scopolamine for the prevention of postoperative nausea and vomiting: a quantitative systematic review. Anesth Analg 95: 133–143

    Article  PubMed  CAS  Google Scholar 

  50. Lee A, Done ML (1999) The use of nonpharmacologic techniques to prevent postoperative nausea and vomiting: a meta-analysis. Anesth Analg 88: 1362–1369

    Article  PubMed  CAS  Google Scholar 

  51. Lee A, Done ML (2004) Stimulation of the wrist acupuncture point P6 for preventing postoperative nausea and vomiting. Cochrane Database Syst Rev 3: CD003281

    PubMed  Google Scholar 

  52. Liu K, Hsu CC, Chia YY (1999) The effect of dose of dexamethasone for antiemesis after major gynecological surgery. Anesth Analg 89: 1316–1318

    PubMed  CAS  Google Scholar 

  53. Madan R, Perumal T, Subramaniam K et al. (2000) Effect of timing of ondansetron administration on incidence of postoperative vomiting in paediatric strabismus surgery. Anaesth Intensive Care 28: 27–30

    PubMed  CAS  Google Scholar 

  54. Melnick B, Sawyer R, Karambelkar D et al. (1989) Delayed side effects of droperidol after ambulatory general anesthesia. Anesth Analg 69: 748–751

    Article  PubMed  CAS  Google Scholar 

  55. Palazzo M, Evans R (1993) Logistic regression analysis of fixed patient factors for postoperative sickness: a model for risk assessment. Br J Anaesth 70: 135–140

    Article  PubMed  CAS  Google Scholar 

  56. Parlow JL, Costache I, Avery N, Turner K (2004) Single-dose haloperidol for the prophylaxis of postoperative nausea and vomiting after intrathecal morphine. Anesth Analg 98: 1072–1076

    Article  PubMed  CAS  Google Scholar 

  57. Pierre S, Benais H, Pouymayou J (2002) Apfel’s simplified score may favourably predict the risk of postoperative nausea and vomiting. Can J Anaesth 49: 237–242

    Article  PubMed  Google Scholar 

  58. Pierre S, Corno G, Benais H, Apfel CC (2004) A risk score-dependent antiemetic approach effectively reduces postoperative nausea and vomiting – A continuous quality improvement initiative. Can J Anaesth 51: 320–325

    PubMed  Google Scholar 

  59. Sun R, Klein KW, White PF (1997) The effect of timing of ondansetron administration in outpatients undergoing otolaryngologic surgery. Anesth Analg 84: 331–336

    Article  PubMed  CAS  Google Scholar 

  60. Tang J, Chen L, White PF et al. (1999) Recovery profile, costs, and patient satisfaction with propofol and sevoflurane for fast-track office-based anesthesia. Anesthesiology 91: 253–261

    Article  PubMed  CAS  Google Scholar 

  61. Tang J, Watcha MF, White PF (1996) A comparison of costs and efficacy of ondansetron and droperidol as prophylactic antiemetic therapy for elective outpatient gynecologic procedures. Anesth Analg 83: 304–313

    Article  PubMed  CAS  Google Scholar 

  62. Taylor AM, Rosen M, Diemunsch PA et al. (1997) A double-blind, parallel-group, placebo-controlled, dose-ranging, multicenter study of intravenous granisetron in the treatment of postoperative nausea and vomiting in patients undergoing surgery with general anesthesia. J Clin Anesth 9: 658–663

    Article  PubMed  CAS  Google Scholar 

  63. Toner CC, Broomhead CJ, Littlejohn IH et al. (1996) Prediction of postoperative nausea and vomiting using a logistic regression model. Br J Anaesth 76: 347–351

    PubMed  CAS  Google Scholar 

  64. Toprak V, Keles GT, Kaygisiz Z, Tok D (2004) Subcutaneous emphysema following severe vomiting after emerging from general anesthesia. Acta Anaesthesiol Scand 48: 917–918

    Article  PubMed  CAS  Google Scholar 

  65. Traeger M, Eberhart A, Geldner G et al. (2003) Prediction of postoperative nausea and vomiting using an artificial neural network. Anaesthesist 52: 1132–1138

    Article  PubMed  CAS  Google Scholar 

  66. Tramèr MR, Moore A, McQuay H (1996) Omitting nitrous oxide in general anaesthesia: meta-analysis of intraoperative awareness and postoperative emesis in randomized controlled trials. Br J Anaesth 76: 186–193

    PubMed  Google Scholar 

  67. Tramèr MR, Moore A, McQuay H (1997) Propofol anaesthesia and postoperative nausea and vomiting: quantitative systematic review of randomized controlled studies. Br J Anaesth 78: 247–255

    PubMed  Google Scholar 

  68. Tramèr MR, Moore RA, Reynolds DJ, McQuay HJ (1997) A quantitative systematic review of ondansetron in treatment of established postoperative nausea and vomiting. BMJ 314: 1088–1092

    PubMed  Google Scholar 

  69. Tramèr MR, Reynolds DJ, Moore RA, McQuay HJ (1997) Efficacy, dose-response, and safety of ondansetron in prevention of postoperative nausea and vomiting: a quantitative systematic review of randomized placebo-controlled trials. Anesthesiology 87: 1277–1289

    Article  PubMed  Google Scholar 

  70. Turner KE, Parlow JL, Avery ND et al. (2004) Prophylaxis of postoperative nausea and vomiting with oral, long-acting dimenhydrinate in gynecologic outpatient laparoscopy. Anesth Analg 98: 1660–1664

    Article  PubMed  CAS  Google Scholar 

  71. Van den Bosch JE, Kalkman CJ, Vergouwe Y et al. (2005) Assessing the applicability of scoring systems for predicting postoperative nausea and vomiting. Anaesthesia 60: 323–331

    Article  Google Scholar 

  72. Wang JJ, Ho ST, Lee SC et al. (2000) The use of dexamethasone for preventing postoperative nausea and vomiting in females undergoing thyroidectomy: a dose-ranging study. Anesth Analg 91: 1404–1407

    Article  PubMed  CAS  Google Scholar 

  73. Wang JJ, Ho ST, Tzeng JI, Tang CS (2000) The effect of timing of dexamethasone administration on its efficacy as a prophylactic antiemetic for postoperative nausea and vomiting. Anesth Analg 91: 136–139

    Article  PubMed  CAS  Google Scholar 

  74. White PF, Song D, Abrao J et al. (2005) Effect of low-dose droperidol on the QT interval during and after general anesthesia: a placebo-controlled study. Anesthesiology 102: 1101–1105

    Article  PubMed  CAS  Google Scholar 

  75. Wilson AJ, Diemunsch P, Lindeque BG et al. (1996) Single-dose i.v. granisetron in the prevention of postoperative nausea and vomiting. Br J Anaesth 76: 515–518

    PubMed  CAS  Google Scholar 

  76. Yang LC, Jawan B, Chen CN et al. (1993) Comparison of P6 acupoint injection with 50% glucose in water and intravenous droperidol for prevention of vomiting after gynecological laparoscopy. Acta Anaesthesiol Scand 37: 192–194

    PubMed  CAS  Google Scholar 

Download references

Interessenkonflikt

Dr. C.C. Apfel erhielt in den letzten zwei Jahren Honorare für Vorträge und Beratungstätigkeit von GlaxoSmithKline (Philadelphia, PA), Merck (Whitehouse Station, NJ), MGI-Pharma (Bloomington, MN) und Fresenius Kabi (Bad Homburg). Er war auch an klinischen Studien beteiligt, die von Merck (Whitehouse Station, NJ) and MGI-Pharma (Bloomington, MN) unterstützt wurden.

Dr. P. Kranke, MBA, erhielt in den letzten zwei Jahren Honorare für Vorträge und Beratungstätigkeit von GlaxoSmithKline GmbH & Co. KG (München, Deutschland), Bayer Healthcare AG (Wuppertal, Deutschland), Fresenius Kabi Deutschland GmbH (Bad Homburg, Deutschland), Baxter Deutschland GmbH (Erlangen, Deutschland) und Pfizer GmbH (Karlsruhe, Deutschland).

Prof. D.R. Spahn erhielt in den letzten 12 Monaten Honorare für Beratungstätigkeit der Firmen B.Braun (Melsungen und Schweiz) sowie Novo Nordisk, Dänemark.

Prof. B. Zwissler erhielt in den letzten Jahren Honorare für Vorträge von Schering (Berlin), Abbott (Wiesbaden) und Fresenius-Kabi (Bad Homburg).

Prof. M. Steinfath hat in den letzten Jahren Vorträge auf Symposien und Fortbildungsveranstaltungen gehalten, die von den Firmen GlaxoSmithKline GmbH & Co. KG (München, Deutschland) und Fresenius-Kabi (Bad-Homburg, Deutschland) unterstützt wurden.

Priv.-Doz. Dr. S. Piper, Prof. T. Möllhoff, Dr. K. Danner, Dr. A. Biedler, Dr. O. Danzeisen, Dr. D. Rüsch, Prof. H. Gerber, Dr. M. Hohenhaus, Priv.-Doz. Dr. H. Kerger, Prof. F.J. Kretz, Dr. K. Stöcklein und Dr. J. Speck-Hergenröder gaben keine Interessenkonflikte innerhalb der letzten zwölf Monate an.

Author information

Authors and Affiliations

  1. Perioperative Clinical Research Core, Department of Anesthesia and Perioperative Care, University of California, San Francisco,UCSF Medical Center at Mt. Zion, 1600 Divisadero, C-355, 94115-1605, San Francisco, California, USA

    C.C. Apfel M.D., Ph.D., Associate Professor

  2. Klinik und Poliklinik für Anästhesiologie , Universität Würzburg, Würzburg, Deutschland

    P. Kranke

  3. Klinik für Anaesthesiologie und Operative Intensivmedizin, Klinikum Ludwigshafen, Ludwigshafen, Deutschland

    S. Piper

  4. Klinik für Anästhesie und Intensivtherapie, Universitätsklinikum Gießen und Marburg, Standort Marburg, Marburg, Deutschland

    D. Rüsch

  5. Abteilung Anästhesie, Evangelisches Diakoniekrankenhaus, Freiburg, Deutschland

    H. Kerger

  6. Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland

    M. Steinfath

  7. Klinik für Anaesthesiologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland

    K. Stöcklein

  8. Service d’Anesthesiologie, CHUV, Lausanne, Schweiz

    D.R. Spahn

  9. Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Marienhospital Aachen, Aachen, Deutschland

    T. Möllhoff

  10. Institut für Anästhesiologie und Notfallmedizin, Westpfalz-Klinikum GmbH, Kaiserslautern, Deutschland

    K. Danner

  11. Klinik für Anästhesie und Intensivmedizin, Kath. Kliniken Essen-Nord, Essen, Deutschland

    A. Biedler

  12. Klinik für Anästhesiologie und operative Intensivmedizin, Klinikum Nürnberg, Nürnberg, Deutschland

    M. Hohenhaus

  13. Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universität Frankfurt, Frankfurt, Deutschland

    B. Zwissler

  14. Anästhesiologische Universitätsklinik, Universität Freiburg, Freiburg, Deutschland

    O. Danzeisen

  15. Institut für Anästhesie, Kantonsspital Luzern, Luzern, Deutschland

    H. Gerber

  16. Klinik für Anästhesiologie, Klinikum Stuttgart, Olgahospital, Stuttgart, Deutschland

    F.-J. Kretz

Authors
  1. C.C. Apfel M.D., Ph.D., Associate Professor
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Kranke
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Piper
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. D. Rüsch
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. H. Kerger
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. Steinfath
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. K. Stöcklein
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. D.R. Spahn
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. T. Möllhoff
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. K. Danner
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. A. Biedler
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. M. Hohenhaus
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. B. Zwissler
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. O. Danzeisen
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. H. Gerber
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. F.-J. Kretz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C.C. Apfel M.D., Ph.D., Associate Professor.

Additional information

Die wissenschaftliche Leitung der Konferenz hatte Herr Apfel. Organisation und Durchführung der Expertenkonferenz lag in den Händen von Herrn J. Speck-Hergenroeder. Herr Apfel, Herr Kranke und Herr Kretz haben gleichermaßen zur Erstellung des Manuskripts beigetragen und teilen sich daher die Erstautorenschaft. Das Projekt wurde durch einen Grant der Fa. Fresenius-Kabi GmbH, Bad Homburg, unterstützt.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Apfel, C., Kranke, P., Piper, S. et al. Übelkeit und Erbrechen in der postoperativen Phase. Anaesthesist 56, 1170–1180 (2007). https://doi.org/10.1007/s00101-007-1210-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00101-007-1210-0

Schlüsselwörter

Keywords

Search

Navigation