Prophylaxis of Postoperative Nausea and Vomiting in Adolescent Patients: A Review with Emphasis on Combination of Fixed-Dose Ondansetron and Transdermal Scopolamine

Abstract

Postoperative nausea and vomiting (PONV) is a relatively common occurrence (20–30%) that delays discharge and, if persistent, can lead to serious complications. The incidence of PONV is a function of patient characteristics, the type and duration of surgery, the type of anesthesia, and the choice of pre-, intra-, and postoperative pharmacotherapy. There are no completely effective antiemetic agents for this condition, but recommendations for treatment strategies are separately available for pediatric and adult patients. Left unclear is whether adolescents should be guided by the pediatric or the adult recommendations. We review the developmental physiology of the relevant physiological factors (absorption, distribution, metabolism, and elimination). We also review the clinical evidence regarding the safety and efficacy of a fixed-dose combination of ondansetron (4 mg, i.v.) and transdermal scopolamine (1.5 mg).

The Use of Transdermal Therapeutic Systems in Psychiatric Care: A Primer on Patches

“…Scopolamine is a high-affinity selective antagonist of G protein-coupled muscarinic receptor for acetylcholine with both, peripheral and central antimuscarinic effects, including sedative, antiemetic, and amnesic actions. 115 It acts on the CNS by blocking cholinergic transmission from vestibular nuclei to higher CNS centers and from the reticular formation to the vomiting center. 116 The scopolamine transdermal delivery system, comprised of a four-layer film, controls the absorption process and rate of drug entry into the systemic circulation over a 72-hour period.…”

Revisiting transdermal scopolamine for postoperative nausea and vomiting

“…Prophylactic therapy is also appropriate for pediatric surgical patients at elevated risk of PONV, although pediatric risk factors differ somewhat from adult risk factors. 18 Risk stratification is only a tool, because individual patients can still succumb to PONV without any risk factors. Thus, clinicians should always be prepared to offer rescue antiemetic therapy to patients following surgery.…”

“…Scopolamine acts as a nonselective competitor to acetylcholine for muscarinic receptors (nonselective muscarinic antagonist) and has peripheral and central sedative, amnestic, and antiemetic effects. 18 It appears to interrupt cholinergic messages from the vestibular nuclei to higher areas of the central nervous system.…”

“…A priming dose of scopolamine (140 µg) is delivered and followed by a slower continuous release over the next 3 days (0.5 mg/day for 3 days). 18 In about 4 hours after patch application, scopolamine is detectable in the blood, with peak levels achieved around 24 hours. The elimination half-life of scopolamine in the transdermal system is about 9.5 hours.…”

Pharmaceutical technological aspects and possibility of using transdermal patches in paediatric population

“…Na ovaj način je skraćeno vreme koje je potrebno za: uspostavljanje ravnoteže između supstance u rezervoaru i kože, permeaciju skopolamina u sistemsku cirkulaciju i dostizanje terapijskog nivoa. Postaurikularna regija je visoko prokrvljena i permeabilnost za skopolamin je gotovo dvostruko veća u poređenju sa kožom trupa, pa se skopolamin detektuje u plazmi posle 4 h, a maksimalna koncentracija se postiže posle približno 24 h. Po uklanjanju flastera nivo skopolamina u plazmi se eksponencijalno smanjuje, tako da poluvreme eliminacije iznosi približno 9,5 h [24,25].…”