Ondansetron: In a class (5HT3) of its own

Abstract

Summary PONV is increasing in importance for the practice of anesthesiology today. Patients are more commonly aware of this problem and desire that it be prevented. An understanding of the factors which predict an increased likelihood of PONV aids the selection of techniques to reduce its frequency. Ondansetron seems to be at least as effective as other antiemetics with a lack of significant sedation or major side effects. This suggests that ondansetron may be particularly useful in the ambulatory surgery setting. However, ondansetron must be judged in light of its somewhat greater acquisition cost. Some questions remain to be answered. The majority of studies reported to date have evaluated women receiving general anesthesia for gynecological surgery because this is such a high-risk population for PONV. Future studies must address different patient populations, both adult and pediatric, having a variety of surgical procedures and anesthetic techniques. Other questions which need further clarification include the timing of administration of antiemetic drugs. Should they be administered prophylactically or only therapeutically? Also, what about combination therapy? Is the coadministration of an agent like droperidol and metoclopramide superior to either alone? As Fred Orkin comments, the fact that “almost 75% of subjects base their preferences on whether emetic symptoms were present suggests that greater efforts should be made to prevent these symptoms.”