Single dose intravenous ondansetron in the prevention of postoperative nausea and vomiting

Abstract

Despite significant advances in the delivery of general anaesthesia, postoperative nausea and vomiting (PONV) continue to be "the big 'little problem' for surgical patients", as described in a recent editorial [I]. Certain patient-related factors (gender, obesity, or history of motion sickness), surgical procedures (laparoscopy, strabismus surgery, or middle ear surgery), and anaesthetic techniques (nitrous oxide, narcotics, or inhalational agents) may affect the incidence of PONV [2]. As more and more surgery is being performed on a day case basis, the need for effective antiemetics, with fewer side effects than those currently in use, is becoming more urgent. Prophylactic antiemetic therapy in patient populations at high risk for PONV may not only be beneficial but also cost-effective if unanticipated hospital admissions for P O W can be avoided.Ondansetron, a 5-hydroxytryptamine subtype 3 (5-HT,) receptor antagonist, is an effective antiemetic in the prevention of chemotherapy-induced emesis [3]. Ondansetron has also been shown to be effective in the prevention [4] and treatment [5] of PONV. The results of three large multicentre, randomised, double-blind, placebo-controlled trials, examining the safety and efficacy of single dose intravenous prophylactic ondansetron in male and female patients, are presented here. MethodWritten informed consent was obtained from all patients after approval of the protocols by the Institutional Review Board at each centre. In study 1, 580 ASA grade 1 or 2 female patients, aged 18-70 years, scheduled to undergo gynaecological laparoscopy on a day case basis, were enrolled. Five hundred and eighty-nine female patients, aged 18-70 years, scheduled to undergo day case surgery, were enrolled in study 2. In study 3,468 ASA grade 1 or 2 male patients, over 12 years of age, scheduled to undergo surgery on a day case basis, were enrolled. Patients who had vomited or received antiemetics within 24 h of surgery, were pregnant or breastfeeding (studies 1 and 2), were scheduled to undergo liver biopsy, required continuous gastric suction intraoperatively, or were greater than 100% over ideal body weight were not studied.Patients in all three studies were stratified into two groups: patients with a history of PONV after general anaesthesia, and patients with no history of PONV or no

Comparison of Ondansetron with Ondansetron and Dexamethasone in prevention of postoperative nausea vomiting in abdominal surgery

“…Our results were comparable with various studies conducted by Claybon et al 1994 12 , Pearman et al 1994 13 , Sung et al 1993 16 and Helmer et al 1993 17 .…”

“…The only adverse effect we found in our study was headache reported in 3 patients in ondansetron and 4 in the ondansetron plus dexamethasone group (Table no. 6) In the study conducted by Lopez et al 1996 11 , headache was the most common adverse effect. Even Pearman et al 1994 13 in his study noted headache to be the most common adverse effect.This might be related to ondansetron.…”

“…We selected ondansetron (5HT 3 receptor antagonist) as our study drug and the dose was selected as 4mg as it was found to be the optimal dose for prevention of PONV as mentioned in different studies 12,13 . Suggestion on mechanism of action of dexamethasone include central or peripheral inhibition of production or secretion of serotonin, central inhibition of synthesis of prostaglandins or changes in the permeability of blood brain barrier to serum proteins 6,8,9 .…”

Breast Augmentation: Reducing Postoperative Nausea and Vomiting. A Prospective Study

“…However, several studies have reported improved efficacy of ondasetron over metoclopramide and droperidol [11][12][13]. Ondasetron is a 5HT3 receptor antagonist that block the receptors in the chemotactic trigger zone (CTZ) as well as vagal nerve terminals and has a negligible side-effects profile [14]. Marcus et al [9] reported that ondasetron reduced the incidence of postoperative emesis and the perception of nausea severity [9].…”

Dexamethasone 8 mg in combination with ondansetron 4 mg appears to be the optimal dose for the prevention of nausea and vomiting after laparoscopic cholecystectomy

“…1 Ondansetron a 5-HT 3 receptor antagonist has provided effective antiemesis in surgical patients. 2 Combination of antiemetic drugs could be an effective method to control severe postoperative nausea and vomiting (PONV), perhaps because there is no single stimulus or cause for PONV. 3 In patients undergoing laparoscopic cholecystectomy, high incidences of PONV have been reported (50-70%).…”