Summary of findings 11. Summary of findings (visual disturbances).
| HARM | |||||||
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Patient or population: adults undergoing any type of surgery under general anaesthesia Interventions: antiemetic drugs (monoprophylaxis and combination prophylaxis)* Comparator (reference): placebo (or no treatment) Outcome: visual disturbances within 7 days postoperatively Setting: inpatient and outpatient | |||||||
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Total studies: 21 RCTs Total participants: 3634 Number of treatments: 12 Geometry of the network** |
Relative effect*** (95% CI) |
Anticipated absolute effect **** (95% CI) | Certainty of evidence |
Ranking ***** (P score) |
Interpretation of findings | ||
| Without intervention | With intervention | Difference | |||||
| 5‐HT3 receptor antagonists | |||||||
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Dolasetron (0 RCTs; 0 participants) |
NA | NA | NA | NA | NA | NA | No studies were found that looked at visual disturbances |
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Granisetron (0 RCTs; 0 participants) |
NA | NA | NA | NA | NA | NA | No studies were found that looked at visual disturbances |
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Ondansetron (3 RCTs; 506 participants) |
1.29 (0.73 to 2.27) |
75 per 10001 | 97 per 1000 | 22 more per 1000 (20 fewer to 95 more) |
⊕⊕⊖⊖ Low Due to imprecision2 |
Rank 10 (0.3694) Rank 9 of 10 single drugs |
Ondansetron may increase visual disturbances |
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Palonosetron (0 RCTs; 0 participants) |
NA | NA | NA | NA | NA | NA | No studies were found that looked at visual disturbances |
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Ramosetron (0 RCTs; 0 participants) |
NA | NA | NA | NA | NA | NA | No studies were found that looked at visual disturbances |
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Tropisetron (1 RCT; 97 participants) |
0.90 (0.35 to 2.29) |
75 per 10001 | 68 per 1000 | 8 fewer per 1000 (49 fewer to 97 more) |
⊕⊖⊖⊖ Very low Due to study limitations, imprecision3 |
Rank 6 (0.5558) Rank 6 of 10 single drugs |
We are uncertain whether tropisetron reduces visual disturbances |
| D2 receptor antagonists | |||||||
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Amisulpride (0 RCTs; 0 participants) |
NA | NA | NA | NA | NA | NA | No studies were found that looked at visual disturbances |
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Droperidol (5 RCTs; 682 participants) |
0.66 (0.36 to 1.22) |
75 per 10001 | 50 per 1000 | 25 fewer per 1000 (48 fewer to 17 more) |
⊕⊖⊖⊖ Very low Due to study limitations, imprecision4 |
Rank 3 (0.7073) Rank 3 of 10 single drugs |
We are uncertain whether droperidol reduces visual disturbances |
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Haloperidol (0 RCTs; 0 participants) |
NA | NA | NA | NA | NA | NA | No studies were found that looked at visual disturbances |
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Metoclopramide (1 RCT; 100 participants) |
1.29 (0.58 to 2.88) |
75 per 10001 | 97 per 1000 | 22 more per 1000 (32 fewer to 141 more) |
⊕⊕⊖⊖ Low Due to imprecision2 |
Rank 9 (0.3759) Rank 8 of 10 single drugs |
Metoclopramide may increase visual disturbances |
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Perphenazine (0 RCTs; 0 participants) |
NA | NA | NA | NA | NA | NA | No studies were found that looked at visual disturbances |
| NK1 receptor antagonists | |||||||
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Aprepitant (0 RCTs; 0 participants) |
NA | NA | NA | NA | NA | NA | No studies were found that looked at visual disturbances |
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Casopitant (0 RCTs; 0 participants) |
NA | NA | NA | NA | NA | NA | No studies were found that looked at visual disturbances |
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Fosaprepitant (0 RCTs; 0 participants) |
NA | NA | NA | NA | NA | NA | No studies were found that looked at visual disturbances |
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Rolapitant (0 RCTs; 0 participants) |
NA | NA | NA | NA | NA | NA | No studies were found that looked at visual disturbances |
| Corticosteroids | |||||||
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Dexamethasone (1 RCT; 40 participants) |
0.83 (0.27 to 2.54) |
75 per 10001 | 62 per 1000 | 13 fewer per 1000 (55 fewer to 116 more) |
⊕⊕⊖⊖ Low Due to imprecision2,5 |
Rank 5 (0.5737) Rank 5 of 10 single drugs |
Dexamethasone may reduce visual disturbances |
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Methylprednisolone (1 RCT; 96 participants) |
0.32 (0.01 to 7.92) |
75 per 10001 | 24 per 1000 | 51 fewer per 1000 (74 fewer to 519 more) |
⊕⊖⊖⊖ Very low Due to study limitations, imprecision3,5 |
Rank 2 (0.7236) Rank 2 of 10 single drugs |
We are uncertain whether methylprednisolone reduces visual disturbances |
| Antihistamines | |||||||
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Dimenhydrinate (0 RCTs; 0 participants) |
NA | NA | NA | NA | NA | NA | No studies were found that looked at visual disturbances |
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Meclizine (0 RCTs; 0 participants) |
NA | NA | NA | NA | NA | NA | No studies were found that looked at visual disturbances |
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Promethazine (0 RCTs; 0 participants) |
NA | NA | NA | NA | NA | NA | No studies were found that looked at visual disturbances |
| Anticholinergics | |||||||
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Scopolamine (8 RCTs; 683 participants) |
2.01 (1.28 to 3.17) |
75 per 10001 | 151 per 1000 | 76 more per 1000 (21 more to 163 more) |
⊕⊕⊖⊖ Low Due to study limitations, heterogeneity |
Rank 11 (0.1890) Rank 10 of 10 single drugs |
Scopolamine may increase visual disturbances |
| Comparator | |||||||
| Placebo | Reference comparator | Not estimable | Not estimable | Not estimable | Reference comparator |
Rank 7 (0.5098) |
Reference comparator |
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NMA‐SoF table definitions: * Certainty of evidence was assessed only for single antiemetic drugs of direct interest. ** Geometry of the network is presented in Figure 26 (netgraph). *** Network estimates are reported as risk ratio (RR) with confidence interval (CI). **** Anticipated absolute effects. The anticipated absolute effect compares two risks by calculating the difference between the risk of the intervention group and the risk of the control group. ***** Ranking of treatments includes all single drugs and combinations of drugs and is based on the P score (a value on a continuous 0 to 1 scale), which measures the extent of certainty that a treatment is better than another treatment, averaged over all competing treatments (Supplementary Files‐10‐visual disturbances). Larger P scores indicate better treatments. In addition, the rank of the treatment out of all single drugs is indicated. | |||||||
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GRADE working group grades of evidence (or certainty of the evidence). High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate. The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited. The true effect may be substantially different from the estimate of effect. Very low certainty: we have very little confidence in the effect estimate. The true effect is likely to be substantially different from the estimate of effect. | |||||||
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Explanatory footnotes: 1 Baseline risks (assumed control risk) are based on the total events of all placebo groups included in the outcome visual disturbances. The general incidence of visual disturbances after surgery with placebo is about 7.46%. 2 Very serious concerns for imprecision. 3 Very serious concerns for study limitations and imprecision. 4 Serious concerns for study limitations and very serious concerns for imprecision. 5 Poorly connected to the network. Only direct evidence available. | |||||||