***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Because no completely effective antiemetic exists for the prevention of postoperative nausea and vomiting ( PONV ) , we hypothesize that a multimodal approach to management of PONV may reduce both vomiting and the need for rescue antiemetics in high-risk patients . After IRB approval , women undergoing outpatient laparoscopy were r and omized to one of three groups . Group I ( n = 60 ) was managed by using a predefined multimodal clinical care algorithm .  Patients undergoing the same surgical procedure who received a st and ard balanced outpatient anesthetic with ondansetron 4 mg ( Group II , n = 42 ) or placebo ( Group III , n = 37 ) prophylaxis were chosen to establish baseline incidence of nausea and vomiting . None of the Group I patients vomited before discharge , compared with 7 % in Group II ( P = 0.07 ) and 22 % in Group III ( P = 0.0003 ) . However , one patient ( 2 % ) in Group I required treatment for symptoms in the postanesthesia care unit , compared with 24 % in Group II ( P < 0.0001 ) and 41 % in Group III ( P < 0.0001 ) . Time to discharge-ready was significantly shorter in Group I ( 128 , 118–139 min ; mean , 95 % confidence interval ) versus Group II ( 162 , 145–181 min;P = 0.0015 ) and Group III ( 192 , 166–222 min;P = 0.0001 ) . Patient satisfaction with control of PONV was not different between Group I and Group II . Return to normal daily activity and overall satisfaction were not different among groups . Multimodal management result ed in a 98 % complete response rate and a 0 % incidence of vomiting before discharge ; however , this improvement did not result in an increased level of patient satisfaction when compared with routine monotherapy prophylaxis . We conclude that both multimodal management and routine monotherapy antiemetic prophylaxis result ed in an increased level of patient satisfaction than symptomatic treatment in this high-risk population . Implication s Use of a multimodal clinical care algorithm eliminates predischarge vomiting and improves satisfaction in patients undergoing outpatient laparoscopy Two hundred adults undergoing laparoscopic cholecystectomy were enrolled in a prospect ively r and omized , double-blind investigation comparing ondansetron , 4 mg ( Group O ) with the combination of droperidol , 0.625 mg , and metoclopramide , 10 mg ( Group DM ) . Antiemetic drugs were administered intravenously ( IV ) after induction of general anesthesia ( propofol , desflurane ) . Moderate or severe nausea in the postanesthesia care unit was treated with the crossover drug , i.e. , ondansetron for patients in Group DM or droperidol plus metoclopramide for patients in Group O. Data were analyzed using t-tests and chi squared analyses , with P < 0.05 considered statistically significant . The groups were similar with respect to gender , age , weight , duration of surgery , number receiving intraoperative atropine or ephedrine , number admitted overnight , and time to discharge home . Of 102 patients in Group O , 44 required antiemetics in the postanesthesia care unit , compared with 24 of 98 patients in Group DM ( P < 0.01 ) . One patient ( in Group DM ) was admitted for persistent nausea . In conclusion , droperidol 0.625 mg IV in combination with metoclopramide 10 mg IV was more effective in preventing postoperative nausea than was ondansetron 4 mg IV in patients undergoing laparoscopic cholecystectomy , with no difference in the time to discharge . ( Anesth Analg 1996;83:1081 - 3 STUDY OBJECTIVE To evaluate the efficacy of a two-dose combination of droperidol and ondansetron as compared with single-dose droperidol alone , single-dose combined droperidol and ondansetron , and two-dose droperidol alone , for management of postoperative nausea and vomiting ( PONV ) among gynecologic laparoscopy out patients . DESIGN R and omized , double-blind comparison trial . SETTING Tertiary outpatient gynecologic unit . PATIENTS A total of 120 female patients scheduled for gynecologic laparoscopy were enrolled . Patients who had experienced nausea or vomiting , or who had taken drugs with antiemetic action in the 24-hour period prior to the study , as well as breast-feeding mothers , were excluded from participation . INTERVENTIONS Patients were assigned to four treatment groups : i ) single dose of droperidol 1.25 mg , ii ) two doses of droperidol 1.25 mg , iii ) single dose of droperidol 1.25 mg and ondansetron 4 mg in combination , and iv ) two doses of droperidol 1.25 mg and ondansetron 4 mg in combination . The first dose of antiemetic was administered prior to induction and the second dose was given by infusion 4 hours later , prior to discharge . MEASUREMENTS AND MAIN RESULTS A visual analogue scale ( VAS , 10 cm ) was used to obtain patients ' experience of nausea , vomiting , and pain at 0.5 , 1.5 , 2.5 , and 3.5 hours after arrival at the postanesthetic care unit ( PACU ) . Following discharge , approximately 24 hours after arrival at the PACU , the same measures were obtained by a follow-up interview using a verbal 10-point scale . No significant differences in incidence of PONV were noted among the four treatment groups ( p = 0.419 ) . However , both single- and two-dose droperidol and ondansetron combination therapy demonstrated attenuation of PONV severity in the 3.5- to 24-hour postinduction period ( p < 0.05 ) . CONCLUSIONS The findings of this study suggest that prophylactic two-dose combined ondansetron and droperidol offers no added benefit over single-dose therapy for routine use in the gynecologic outpatient population STUDY OBJECTIVES To investigate the hypothesis that the combination of ondansetron and droperidol would be more effective than droperidol alone in reducing nausea and vomiting . DESIGN R and omized , doubleblind study . SETTING Magee-Womens Hospital , Pittsburgh , Pennsylvania . PATIENTS 160 healthy , ASA physical status I and II , female patients scheduled for total abdominal hysterectomy . INTERVENTIONS After induction of anesthesia with propofol , Group 1 received intravenous ( i.v . ) droperidol 1.25 mg plus i.v . ondansetron 4 mg . Group 2 received i.v . droperidol plus i.v . saline . MEASUREMENTS AND MAIN RESULTS The complete response ( no emesis , no rescue ) for Group 1 was 36 of 80 patients ( 45 % ) versus 30 of 80 patients ( 38 % ) in Group 2 ( p = 0.21 ) . In Group 1 , 42 of 80 patients ( 53 % ) required rescue antiemetic as compared with 44 of 80 patients ( 55 % ) in Group 2 ( p = 0.43 ) . There were 72 total rescues in Group 1 versus 73 in Group 2 , ( p = 0.24 ) . Mean time until first rescue was 578 + /- 429 minutes in Group 1 and 418 + /- 354 minutes in Group 2 , ( p = 0.03 ) . In Group 1 , 81 % ( 34/42 ) were rescued for nausea only versus 90 % ( 39/44 ) of Group 2 ( p = 0.16 ) . In Group 1 , 21 % of patients ( 17/80 ) had at least one emetic episode versus 34 % ( 27/80 ) of Group 2 patients ( p = 0.05 ) . There were 31 emetic episodes in Group 1 versus 72 episodes in Group 2 . ( p = 0.02 ) . Mean time to the first emetic episode was 699 + /- 403 minutes in Group 1 and 616 + /- 376 minutes in Group 2 , ( p = 0.23 ) . CONCLUSION For patients undergoing total abdominal hysterectomies , the addition of ondansetron to droperidol increases the time until first rescue and reduces the number of emetic episodes , as well as the percentage of patients , having at least one emetic episode PURPOSE A relatively high incidence of postoperative nausea and vomiting ( PONV ) occurs in patients undergoing laparoscopic cholecystectomy . This study was undertaken to compare the efficacy of granisetron-droperidol combination with each drug alone for the prevention of PONV after laparoscopic cholecystectomy . METHODS In a r and omized , double-blind manner , 150 female in patients received 3 mg granisetron ( Group G ) , 1.25 mg droperidol ( Group D ) or 3 mg granisetron plus 1.25 mg droperidol ( Group GD)(n = 50 for each ) i.v . immediately before the induction of anaesthesia . The same st and ard general anaesthetic technique , which consisted of isoflurane and nitrous oxide in oxygen , was used . Nausea , vomiting and safety assessment s were performed continuously during the first 24 hr after anaesthesia . RESULTS Complete response , defined as no PONV and no administration of rescue antiemetic medication , was 86 % in Group G , 64 % in Group D and 98 % in Group GD ( P = 0.03 vs Group G , P = 0.001 vs Group D ) . No clinical ly adverse events were observed in any group . CONCLUSION Granisetron-droperidol combination is more effective than each antiemetic alone in the prevention of PONV after laparoscopic cholecystectomy Drugs with anti-emetic properties can exert their actions at more than one receptor site , histamine H1 , muscarinic cholinergic or dopaminergic D2 receptors . This study was design ed to test the hypothesis that a combination of drugs acting at different receptor sites in lower than st and ard doses would be at least as effective as a st and ard therapeutic dose of a single anti-emetic agent . A combination of droperidol , hyoscine and metoclopramide in subtherapeutic doses has been shown to be at least as effective as droperidol ( 1.25 mg ) alone . In both groups there was a low incidence of emetic sequelae in the first 3 hours postoperatively Purpose This study tested the hypothesis that the antiemetic effects of a combination of ondansetron and propofol were superior to propofol alone in children undergoing tonsillectomy surgery . Methods A prospect i ve , r and omized , double-blind , placebo-controlled study design was employed . Young children underwent mask induction with halothane , nitrous oxide and oxygen and then hadiv access established : older children hadiv induction with propofol . All patients received 0.3 mg·kg−1 mivacurium and 2–4 μg·kg−1 fentanyliv and 30 mg·kg−1 acetaminophenpr to a maximum dose of 650 mg . Following induction , patients received either 100 μg·kg−1 ondansetron or placebo . Anaesthesia was maintained with 120 – 140 μg·kg−1·min−1 propofol , nitrous oxide and oxygen to maintain vital signs within 20 % of baseline . After surgery , in all patients the tracheas were extubated in the operating room without use of neuromuscular reversing agents . Episodes of emesis were recorded by PACU nurses for four to six hours . A telephone interview on the following day was also used for data recovery . Groups were compared in relation to age using the Mann-Whitney test , and with respect to sex and number of episodes of vomiting using the Fisher Exact Test . Results Three of the 45 patients who received ondansetron  vomited ( 6.7 % ) , whereas 10 of the 45 patients who received placebo vomited ( 22.2 % ) . ( P = 0.035 ) Conclusion Ondansetron in a dose of 100 μg·kg−1 , when combined with propofol for children undergoing ton-sillectomy  reduced the incidence of postoperative vomiting to very low levels . RésuméObjectifVérifier l’hypothèse voulant que les effets antiémétiques d’une combinaison d’ondansétron et de propofol soit supérieure à ceux du propofol seul chez des enfants qui subissent une amygdalectomie . MéthodeOn a utilisé une étude prospect i ve , r and omisée et en double aveugle contre placebo . Chez les jeunes enfants , l’induction au masque s’est faite avec de l’halothane et un mélange de protoxyde d’azote et d’oxygène , et on a établi ensuite l’accèsiv ; chez les enfants plus âgés , c’était une inductioniv avec du propofol . Tous les patients ont reçu 0,3 mg·kg−1 de mivacurium et 2 —  
    Output:
    
The 5-HT3 receptor antagonists are considered to be effective antiemetics with an acceptable side effects profile .
Ondansetron was the most commonly studied member of this group .
Another effective antiemetic is  droperidol .
A single dose of dexamethasone has been reported to be effective for PONV prophylaxis without evidence of significant side effects .
It has also been suggested that dexamethasone might be especially effective against late PONV .