Gender-Specific Differences in Low-Dose Haloperidol Response for Prevention of Postoperative Nausea and Vomiting: A Register-Based Cohort Study

• Published in: PloS one 2016-01, Vol.11 (1), p.e0146746-e0146746
• Main Authors: Brettner, Florian, Janitza, Silke, Prüll, Kathrin, Weninger, Ernst, Mansmann, Ulrich, Küchenhoff, Helmut, Jovanovic, Alexander, Pollwein, Bernhard, Chappell, Daniel, Zwissler, Bernhard, von Dossow, Vera
• Format: Article
• Language: English
• Subjects: Aged; Analgesics, Opioid - therapeutic use; Analysis; Anesthesia; Anesthesia, General; Anesthesiology; Antiemetics - therapeutic use; Biometrics; Central nervous system depressants; Cohort analysis; Cohort Studies; Complications; Complications and side effects; Confidence intervals; Documentation; Dosage and administration; Drug dosages; Drug therapy; Epidemiology; Female; Females; Gender; Gender differences; Haloperidol; Haloperidol - therapeutic use; Health informatics; Hospitals; Humans; Incidence; Laparoscopy; Male; Middle Aged; Multivariate Analysis; Narcotics; Nausea; Odds Ratio; Ondansetron - therapeutic use; Opioids; Pain Management - methods; Pain, Postoperative - drug therapy; Patient outcomes; Patients; Postoperative Nausea and Vomiting - etiology; Postoperative Nausea and Vomiting - prevention & control; Postoperative Period; Prevention; Registries; Regression Analysis; Regression models; Risk analysis; Risk factors; Risk groups; Sex Factors; Smoking; Statistical analysis; Studies; Surgery; Universities; Vomiting
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0146746

Postoperative nausea and vomiting (PONV) is one of the most common and distressing complications after general anesthesia and surgery, with young non-smoking females receiving postoperative opioids being high-risk patients. This register-based study aims to evaluate the effect of low-dose haloperidol (0.5 mg intravenously) directly after induction of general anesthesia to reduce the incidence of PONV in the postoperative anesthesiological care unit (PACU). Multivariable regression models were used to investigate the association between low-dose haloperidol and the occurrence of PONV using a patient registry containing 2,617 surgical procedures carried out at an university hospital. Haloperidol 0.5 mg is associated with a reduced risk of PONV in the total collective (adjusted odds ratio = 0.75, 95% confidence interval: [0.56, 0.99], p = 0.05). The results indicate that there is a reduced risk in male patients (adjusted odds ratio = 0.45, 95% confidence interval: [0.28, 0.73], p = 0.001) if a dose of 0.5 mg haloperidol was administered while there seems to be no effect in females (adjusted odds ratio = 1.02, 95% confidence interval: [0.71, 1.46], p = 0.93). Currently known risk factors for PONV such as female gender, duration of anesthesia and the use of opioids were confirmed in our analysis. This study suggests that low-dose haloperidol has an antiemetic effect in male patients but has no effect in female patients. A confirmation of the gender-specific effects we have observed in this register-based cohort study might have major implications on clinical daily routine.