Abstract
Post operative nausea and vomiting (PONV) are common complications and occurs in as many as 70%- 80% of high risk surgical patients. The latest prophylactic treatment recommended in the Society of Ambulatory Anesthesia Guidelines (SAMBA) for the management of Post operative Nausea and Vomiting for high risk patients is a combination of 2 or more interventions (multimodal therapy). A combination of a 5-HT3 receptor antagonist with Dexamethasone and/or Droperidol, or a 5-HT3 receptor antagonist with Droperidol alone, or Dexamethasone with Droperidol, have been the pharmacologic combination therapies suggested in these guidelines. Scopolamine “Transdermal Scop” is a belladonna alkaloid with anticholinergic properties. It acts as a nonselective muscarinic antagonist, approved by the FDA for PONV prophylaxis. The use of this novel drug in a triple therapy combination with Dexamethasone and/or Droperidol could be an effective treatment for the prevention of PONV. However, since the FDA issued a warning stating that Droperidol may cause life – threatening arrhythmias as well as a prolongation of the QTc interval, the need to discover new combination therapies for PONV prevention in high risk patients is still in demand. Therefore, we hypothesize that the use of a triple prophylactic therapy consisting of Scopolamine, Dexamethasone, and Ondansetron will be an effective treatment for the prevention of PONV in patients at a high risk for developing PONV during the first 120 hours after neurosurgery.
Highlights
Introduction and BackgroundPostoperative nausea and vomiting (PONV) is one of the most common complaints concerning both patients and clinicians [1]
According to the Society for Ambulatory Anesthesia (SAMBA) Consensus Guidelines for the Management of Post operative nausea and vomiting (PONV), the incidence of PONV is between 20-30% of all patients undergoing surgery [6]
An additional study performed by Shari et al [18] examined active Transdermal Scopolamine patch plus Ondansetron compared with Placebo patch plus Ondansetron as a prophylaxis treatment for PONV in 56 high risk patient’s scheduled to receive general anesthesia for no longer than 1 hour
Summary
Postoperative nausea and vomiting (PONV) is one of the most common complaints concerning both patients and clinicians [1]. Some strategies to reduce the baseline risk for PONV include avoidance of general anesthesia, use of Propofol for induction and maintenance of anesthesia, avoidance of Nitrous Oxide and other volatile anesthetics, minimizing the use of opioids during and after the surgery, minimizing the use of Neostigmine and adequate hydration [6]. These PONV risk elevating techniques cannot be avoided during this type of neurological surgery.
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