Neurokinin-1 receptor antagonists for postoperative nausea and vomiting: a systematic review and meta-analysis / Antagonistas do receptor da neurocinina-1 no tratamento de náusea e vômito no pós-operatório: Revisão sistemática e meta-análise

Abstract Background: Postoperative Nausea and Vomiting (PONV) is a common complication of general anesthesia. Several kinds of antiemetics, including 5-Hydroxytryptamine3 (5-HT3) receptor antagonists, and Neurokinin-1 (NK-1) receptor antagonists have been used to treat PONV. Objectives: To compare the antiemetic effect of NK-1 receptor antagonists, including fosaprepitant. Data sources: Online databases (PubMed, MEDLINE, Scopus, The Cochrane Library databases) were used. Study eligibility criteria, participants, and interventions: Randomized Controlled Trials (RCTs) performed in patients over 18 years with ASA-PS of I‒III, aimed to assess the efficacy of antiemetics including NK-1 receptor antagonists and 5-HT3 receptor antagonists, and compared the incidence of PONV were included. Study appraisal and synthesis methods: All statistical assessments were conducted by a random effect approach, and odds ratios and 95% Confidence Intervals were calculated. Results: Aprepitant 40 mg and 80 mg significantly reduced the incidence of vomiting 0‒24 hours postoperatively (Odds Ratio [OR = 0.40]; 95% Confidence Interval [95% CI 0.30‒0.54]; p < 0.001, and OR = 0.32; 95% CI 0.19‒0.56; p < 0.001). Fosaprepitant could also reduce the incidence of vomiting significantly both 0‒24 and 0‒48 hours postoperatively (OR = 0.07; 95% CI 0.02‒0.24; p < 0.001 and OR = 0.07; 95% CI 0.02‒0.23; p < 0.001). Limitations: Risk factors for PONV are not considered, RCTs using multiple antiemetics are included, RCTs for fosaprepitant is small, and some bias may be present. Conclusions and implications of key findings: Aprepitant and fosaprepitant can be effective prophylactic antiemetics for postoperative vomiting. However, more studies are required for higher-quality meta-analyses. Systematic review registration number: CRD42019120188.

Resumo Histórico: Náusea e Vômito no Pós-Operatório (NVPO) é um evento adverso frequente da anestesia geral. Várias classes de antieméticos, incluindo antagonistas do receptor 5-Hidroxitriptamina3 (5-HT3) e antagonistas do receptor da Neurocinina-1 (NK-1), têm sido utilizados para tratar a NVPO. Objetivo: Comparar o efeito antiemético dos antagonistas do receptor NK-1, incluindo o fosaprepitanto. Fontes de dados: Foram utilizadas bases de dados on-line (PubMed, MEDLINE, Scopus, The Cochrane Library). Critérios de elegibilidade do estudo, participantes e intervenções: Foram incluídos Estudos Clínicos Randomizados (ECR) realizados em pacientes acima de 18 anos classificação ASA I a III, com o objetivo de avaliar a eficácia de antieméticos que incluíssem antagonistas do receptor NK-1 e antagonistas do receptor 5-HT3, e que comparassem a incidência de NVPO. Métodos de avaliação e síntese do estudo: Todas as avaliações estatísticas foram realizadas por abordagem de efeito aleatório e foram calculadas razões de chances e Intervalos de Confiança de 95%. Resultados: As doses de 40 mg e 80 mg de aprepitanto reduziram significantemente a incidência de vômito no período de 0 a 24 horas pós-operatórias (razão de chances [OR = 0,40]; Intervalo de Confiança de 95% [95% IC] 0,30-0,54; p < 0,001 e OR = 0,32; 95% IC 0,19-0,56; p < 0,001). O fosaprepitanto pode também reduzir significantemente a incidência de vômito tanto de 0-24 horas como no período de 0-48 horas pós-operatórias (OR = 0,07; 95% IC 0,02-0,24; p < 0,001 e OR = 0,07; 95% IC 0,02-0,23; p < 0,001). Limitações: Os fatores de risco para NVPO não foram analisados, ECRs usando múltiplos antieméticos foram incluídos, ECRs para fosaprepitanto tinham amostras pequenas, podendo haver algum viés. Conclusões e implicações dos principais achados: Aprepitanto e fosaprepitanto podem ser drogas antieméticas profiláticas efetivas para vômito no pós-operatório. No entanto, são necessários mais estudos para elaboração de meta-análises de melhor qualidade. Número de registro da revisão sistemática: CRD42019120188.

The effect of palonosetron on rocuronium-induced withdrawal movement / O efeito de palonosetron sobre o movimento de retração induzido por rocurônio

Abstract Background: Rocuronium causes pain and withdrawal movement during induction of anesthesia. In this study, palonosetron was investigated to have analgesic effect on the reduction of rocuronium-induced withdrawal movement. Methods: 120 patients were randomly assigned to one of three groups to receive either saline, lidocaine 20 mg, or palonosetron 0.075 mg with a tourniquet applied two minutes before thiopental sodium (5 mg.kg-1) was given intravenously. After loss of consciousness, rocuronium (0.6 mg.kg-1) was injected and the withdrawal movement was estimated by 4-point scale in a double-blind manner. Results: The overall incidence of rocuronium withdrawal movement was 50% with lidocaine (p = 0.038), 38% with palonosetron (p = 0.006) compared with 75% for saline. The incidence of no pain to mild pain was significantly lower in the lidocaine and palonosetron groups (85% and 92% respectively) than in the saline group (58%). However, there was no significant difference in withdrawal movement between the lidocaine and palonosetron groups. There was no severe movement with palonosetron. Conclusion: Pretreatment of palonosetron with venous occlusion may attenuate rocuronium-induced withdrawal movement as effective as the use of lidocaine. It suggested that peripheral action of palonosetron was effective to reduce rocuronium-induced withdrawal movement.

Resumo Justificativa: Rocurônio provoca dor e reflexo de retirada durante a indução da anestesia. Neste estudo, avaliamos se palonosetron tem efeito analgésico para reduzir esse movimento induzido por rocurónio. Métodos: Cento e vinte pacientes foram randomicamente designados para um de três grupos para receber solução salina, lidocaína (20 mg) ou palonosetron (0.075 mg), com aplicação de torniquete dois minutos antes da administração intravenosa de tiopental sódico (5 mg.kg-1). Após a perda de consciência, rocurônio (0.6 mg.kg-1) foi injetado e o reflexo de retirada foi avaliado com o uso de uma escala de quatro pontos, de modo duplo-cego. Resultados: A incidência global do reflexo de retirada induzido por rocurônio foi de 50% para lidocaína (p = 0,038), 38% para palonosetron (p = 0,006), em comparação com 75% para solução salina. A incidência de dor ausente ou leve foi significativamente menor nos grupos lidocaína e palonosetron (85% e 92%, respectivamente) que no grupo solução salina (58%). Porém, não houve diferença significativa no reflexo de retirada entre os grupos lidocaína e palonosetron. Não houve movimento grave com palonosetron. Conclusão: O pré-tratamento com palonosetron com oclusão venosa pode atenuar o reflexo de retirada induzido por rocurônio de modo tão eficaz como o uso de lidocaína. Sugeriu-se que a ação periférica de palonosetron foi eficaz para reduzir o reflexo de retirada induzido por rocurônio.

Pharmacotherapy of irritable bowel syndrome

Irritable bowel syndrome is a group of symptoms that includes abdominal pain and changes in the form and frequency of stool. Since its symptoms are usually long-lasting, the disease significantly degrades quality of life. Several pharmacological therapies have been suggested according to the type of symptoms (e.g., abdominal pain, constipation, or diarrhea). In order to control abdominal pain, smooth muscle antispasmodics, antidepressants including tricyclic antidepressants and selective serotonin reuptake inhibitors, or 5-HT3 antagonists can be used. To improve constipation, dietary fiber or laxatives, 5-HT4 agonists, and chloride channel activators are available. Opioid agonists, mixed opioid agonists/antagonists such as eluxadoline, and bile salt sequestrants can be considered for diarrhea. In addition, probiotics and non-absorbable oral antibiotics can be used for the normalization of the gut microbiome and the treatment of small intestinal bacterial overgrowth, respectively. It is necessary to understand the characteristics of each drug and their combinations, because any single regimen cannot improve all symptoms in patients with irritable bowel syndrome. In this review, the mechanisms of action, efficacy, and adverse events associated with drugs used for irritable bowel syndrome are summarized.

Pharmacotherapy of irritable bowel syndrome

Irritable bowel syndrome is a group of symptoms that includes abdominal pain and changes in the form and frequency of stool. Since its symptoms are usually long-lasting, the disease significantly degrades quality of life. Several pharmacological therapies have been suggested according to the type of symptoms (e.g., abdominal pain, constipation, or diarrhea). In order to control abdominal pain, smooth muscle antispasmodics, antidepressants including tricyclic antidepressants and selective serotonin reuptake inhibitors, or 5-HT3 antagonists can be used. To improve constipation, dietary fiber or laxatives, 5-HT4 agonists, and chloride channel activators are available. Opioid agonists, mixed opioid agonists/antagonists such as eluxadoline, and bile salt sequestrants can be considered for diarrhea. In addition, probiotics and non-absorbable oral antibiotics can be used for the normalization of the gut microbiome and the treatment of small intestinal bacterial overgrowth, respectively. It is necessary to understand the characteristics of each drug and their combinations, because any single regimen cannot improve all symptoms in patients with irritable bowel syndrome. In this review, the mechanisms of action, efficacy, and adverse events associated with drugs used for irritable bowel syndrome are summarized.

Palonosetron versus granisetron in combination with aprepitant for the prevention of chemotherapy-induced nausea and vomiting in patients with gynecologic cancer / 부인종양

OBJECTIVE: There is no research regarding the appropriate antiemetic agents for female patients, especially those receiving moderately emetogenic chemotherapy (MEC). We evaluated the antiemetic efficacy of a combination of 5-HT3 receptor with/without aprepitant in patients with gynecological cancer treated with the TC (paclitaxel and carboplatin) regimen of MEC. METHODS: We enrolled 38 patients diagnosed with gynecologic cancer and scheduled to receive the TC regimen. The patients were randomly assigned to receive a 5-HT3 receptor antagonist, either palonosetron in the first cycle followed by granisetron in the second cycle or vice versa. In the third cycle, all patients received a combination of the 5-HT3 receptor and dexamethasone with/without aprepitant. RESULTS: When three drugs were administered, palonosetron consistently produced an equivalent complete response (CR) rate to granisetron in the acute phase (89.5% vs. 86.8%, p=0.87) and delayed phase (60.5% vs. 65.8%, p=0.79). With regard to the change in dietary intake, palonosetron exhibited similar efficacy to granisetron in the acute phase (92.1% vs. 89.4%, p=0.19) and delayed phase (65.7% vs. 68.4%, p=0.14). However, in the delayed phase, the addition of aprepitant therapy with a 5-HT3 receptor antagonist and dexamethasone produced a higher CR rate than a 5-HT3 receptor antagonist with dexamethasone (93.3% vs. 47.8%, p<0.001) and allowed the patients to maintain a higher level of dietary intake (93.3% vs. 56.5%, p<0.001). CONCLUSION: The addition of aprepitant therapy was more effective than the control therapy of a 5-HT3 receptor antagonist, and dexamethasone in gynecological cancer patients treated with the TC regimen.

A case of postoperative serotonin syndrome following the administration of fentanyl, palonosetron, and meperidine: A case report

Serotonin syndrome is an unexpected adverse reaction of serotonergic medication. Some drugs used by anesthesiologists may cause serotonin syndrome. Serotonin syndrome is known to be related to 5-hydroxytryptamine 1A and 5-hydroxytryptamine 2A agonism. However, recent research has revealed evidence that 5-hydroxytryptamine 3 (5-HT3) antagonism can also play a role in serotonin syndrome. Among the 5-HT3 antagonists, palonosetron is the most highly specific. In this study, we present the first case of fentanyl- and meperidine-induced serotonin syndrome precipitated by palonosetron in general anesthesia.

Anti-depressant like activity of N-n-butyl-3-methoxyquinoxaline-2-carboxamide (6o) a 5-HT3 receptor antagonist.

The compound 6o (at 0.5, 1 and 2 mg/kg, ip) with optimum log P and pA2 value, was subjected to forced swim test (FST) and tail suspension test (TST). The compound 6o significantly reduced the duration of immobility in mice without affecting the base line locomotion in actophotometer. Moreover, 6o (2 mg/kg, ip), potentiated the 5-hydroxytryptophan (5-HTP)-induced head twitch responses in mice and at 1 and 2 mg/kg, ip antagonized the reserpine-induced hypothermia (RIH) in rats. In interaction studies with various standard drugs/ligands using FST, 6o (1 and 2 mg/kg, ip) potentiated the anti-depressant effect fluoxetine (5 mg/kg, ip) and reversed the depressant effect of parthenolide (1 mg/kg, ip) by reducing the duration of immobility. Furthermore, 6o (1 and 2 mg/kg, ip) potentiated the effect of bupropion (10 mg/kg, ip) in TST. The behavioural anomalies of the olfactory bulbectomised (OBX) rats were augmented by chronic 6o (1 and 2 mg/kg) treatment as observed from the modified open field test (parameters: ambulation, rearing, fecal pellet). The results suggest that compound 6o exhibited anti-depressant like effect in rodent models of depression.

Ramosetron might be useful for treating diabetic diarrhea with a rapid small bowel transit time

No abstract available.

Management of Chemotherapy Induced Nausea and Vomiting / 대한내과학회지

Chemotherapy induced nausea and vomiting (CINV) is typically biphasic. The acute phase usually peaks in 5-6 hours after the administration of chemotherapeutic agents and the delayed phase can occur subsequently over 24hours after chemotherapy. Antiemetic therapy is crucial to prevent this unwanted side effect effectively, and NK1 antagonist, 5-HT3 antagonist, corticosteroid are the main player. The combination and dosing is determined by the emetogenicity of the chemotherapeutic agents to be administrated.

Diagnosis and Treatment of Functional Nausea and Vomiting / 대한내과학회지

Functional nausea and vomiting is a broad term used to be described a subset of individuals who have chronic nausea and vomiting without apparent cause, despite extensive evaluation. According to the Rome III criteria, functional nausea and vomiting can be subdivided into three separate entities: chronic idiopathic nausea, functional vomiting and cyclic vomiting syndrome. Although no specific test can diagnose these diseases, the diagnostic approach requires excellent history taking combined with judicious diagnostic testing to exclude some organic cause of chronic nausea and vomiting. These conditions are probably not psychogenic in origin. Treatment remains empirical for all patients with functional nausea and vomiting. Reassurance and supportive physician-patient relationship, along with use of low-dose tricyclic antidepressants, can be beneficial in caring for patients with chronic idiopathic nausea and functional vomiting. The cornerstones of management for patients with cyclic vomiting syndrome are identifying and avoidance of triggering factors, treatment with prophylactic antimigraine agents, 5-HT3 antagonists, benzodiazepines and 5-HT1 agonists (sumatriptan), with supportive therapy.

Mechanism of Interdigestive Migrating Motor Complex

Migrating motor complex (MMC) is well characterized by the appearance of gastrointestinal contractions in the interdigestive state. This review article discussed the mechanism of gastrointestinal MMC. Luminal administration of 5-hydroxytryptamine (5-HT) initiates duodenal phase II followed by gastrointestinal phase III with a concomitant increase of plasma motilin release in conscious dogs. Duodenal 5-HT concentration is increased during gastric phase II and phase III. Intravenous infusion of motilin increases luminal 5-HT content and induces gastrointestinal phase III. 5-HT4 antagonists significantly inhibits both of gastric and intestinal phase III, while 5-HT3 antagonists inhibited only gastric phase III. These suggest that gastrointestinal MMC cycle is mediated via the interaction between motilin and 5-HT by the positive feedback mechanism. Gastric MMC is regulated via vagus, 5-HT3/4 receptors and motilin, while intestinal MMC is regulated via intrinsic primary afferent neurons and 5-HT4 receptors. Stress is highly associated with the pathogenesis of functional dyspepsia. Acoustic stress attenuates gastric phase III without affecting intestinal phase III in conscious dogs, via reduced vagal activity and increased sympathetic activity. It has been shown that subset of functional dyspepsia patients show reduced vagal activity and impaired gastric phase III. The physiological importance of gastric MMC is a mechanical and chemical cleansing of the empty stomach in preparation for the next meal. The impaired gastric MMC may aggravate dyspeptic symptoms following a food ingestion. Thus, maintaining gastric MMC in the interdigestive state is an important factor to prevent the postprandial dyspeptic symptoms.

The comparative study to evaluate the effect of palonosetron monotherapy versus palonosetron with dexamethasone combination therapy for prevention of postoperative nausea and vomiting / 대한마취과학회지

BACKGROUND: 5-hydroxytryptamine type 3 (5-HT3) receptor antagonists are effective and safe on postoperative nausea and vomiting (PONV). Palonosetron, the newest 5-HT3 antagonist, has potent antiemetic property. We hypothesized that a combination of palonosetron and dexamethasone could more decrease PONV than palonosetron alone. METHODS: Among the patients scheduled to undergo laparoscopic gynecologic surgery, mastoidectomy with tympanoplasty or thyroidectomy under general anesthesia, eighty four female patients with at least two PONV risk factors were enrolled in this study. They were received randomly 0.075 mg palonosetron and 4 mg dexamethasone (group C) or 0.075 mg palonosetron alone (group P). The severity of PONV using Rhodes index and the percentage of complete response during postoperative 24 hours were compared between groups. RESULTS: The frequency of mild/moderate/great/severe PONV based on Rhodes index were 9.8%/0%/0%/0% and 9.3%/2.3%/2.3%/0% in group P and group C, respectively. Complete response for PONV was observed in 90.2% and 86% of patients in group P and group C, respectively. The overall incidence of PONV in group P and C was 9.8% and 14%, respectively. There was no significant difference between the two groups. CONCLUSIONS: There were no differences between palonosetron monotherapy and combination therapy of palonosetron and dexamethasone in patients with high emetogenic risk.

Involvement of opioid, adenosine and 5-HT3 receptors in antinociceptive effects of an ayurvedic polyherbal formulation

The present study was undertaken to evaluate the antinociceptive effects of an ayurvedic polyherbal formulation in rats and mice employing the tail immersion test and acetic acid-induced writhing test, respectively. With the tail immersion method, rats received two different doses [270 and 405 mg/kg BW, p.o.] of a formulation, pethidine [5.4 mg/kg BW, p.o.] as a reference standard and the combination of the higher dose of the formulation with naloxone [2 mg/kg, i.p.], an opioid receptor antagonist, and caffeine [16 mg/kg, i.p.], used as an adenosine receptor antagonist. In the acetic acid-induced writhing test, mice received two different doses [390 and 585 mg/kg, BW, p.o.] of formulation, diclofenac sodium [15 mg/kg, BW, p.o.] as a reference standard and the combination of the higher dose of the polyherbal formulation with ondansetron [0.5 mg/kg, i.p.], a serotonin receptor antagonist. The polyherbal formulation [405 mg/kg] exhibited a significant [p < 0.01] antinociceptive effect using the tail immersion method. In the acetic acid-induced writhing test, the formulation showed significant [p < 0.01] dose-dependent activity. The antinociceptive effect of the polyherbal formulation apparently involved an opiate-like mechanism, since its antinociceptive action was attenuated by naloxone pretreatment. In addition, antinociceptive activity was attenuated by caffeine and reversed by ondansetron pretreatment. Our data suggest that the polyherbal formulation possessed centrally and peripherally mediated antinociceptive properties. The activity could be mediated through opioid, adenosine, and serotonin receptors and via inhibition of cyclo-oxygenase- and/or lipoxygenase-dependent pathways

Comparison of ramosetron's and ondansetron's preventive anti-emetic effects in highly susceptible patients undergoing abdominal hysterectomy / 대한마취과학회지

BACKGROUND: This study compared the preventive effects of ramosetron and ondansetron on postoperative nausea and vomiting (PONV) in highly susceptible patients undergoing abdominal hysterectomy. METHODS: In a prospective, randomized, double-blinded study, a total of 120 highly susceptible women (nonsmokers, those receiving opioid-based IV patient-controlled analgesia [PCA]) undergoing abdominal hysterectomy were included in the study. Patients were divided into 2 groups and each group received either 0.3 mg of ramosetron or 4 mg of ondansetron, IV. All patients received fentanyl-based IV PCA during the 48 h postoperative periods. The incidences of PONV and side effects of 5-HT3 antagonists (headache and dizziness) were assessed at 3 intervals (<2 h, 2-24 h and 24-48 h) postoperatively. RESULTS: Patients in the ramosetron group showed a significantly higher ratio of complete response and lower incidence of nausea during the 24-48 h interval after surgery compared with those the ondansetron group. CONCLUSIONS: Ramosetron (0.3 mg) is more effective in preventing delayed PONV in highly susceptible women undergoing abdominal hysterectomy compared with ondansetron (4 mg).

Guidelines for the Treatment of Functional Dyspepsia / 대한소화기학회지

Functional dyspepsia (FD) is defined as the presence of symptoms thought to originate in the gastroduodenal area, in the absence of any organic, systemic, or metabolic disease that is likely to explain the symptoms. Based on the available evidence and consensus opinion, thirteen consensus statements for the treatment of FD were developed using the modified Delphi approach. Proton pump inhibitor, prokinetics, and histamine 2 receptor antagonists are effective for the treatment of FD. Mucosal protecting agents, fundus relaxant, and drugs for visceral hypersensitivity can improve symptoms in FD. Antacids and antidepressants may help improving symptoms in FD. Comparing endoscopy with 'test and treat' of Helicobacter pylori, endoscopy may be more effective initial strategy for managing patients with FD in Korea given high incidence of gastric cancer and low cost of endoscopy. Helicobacter pylori eradication can be one of the therapeutic options for patients with FD. Psychotherapy is effective for those who have severe symptoms and refractoriness. Further studies are strongly needed to develop better treatment strategies for Korean patients with FD.

Comparison of ramosetron and ondansetron for control of post-operative nausea and vomiting following laparoscopic cholecystectomy.

Background: Post-operative nausea and vomiting (PONV) is common. 5HT 3 receptor antagonists are commonly used drugs for its prevention. A study was designed to compare the efficacy and safety of ramosetron and ondansetron in patients undergoing laparoscopic cholecystectomy (lap chole). Materials and Methods: A prospective randomized case controlled study was conducted at J. N. Medical College Hospital, Aligarh Muslim University, Aligarh, India, in patients who underwent lap chole following intravenous administration of ondansetron (4mg) or ramosetron (0.3mg) at the end of surgery, and efficacy as well as side effects of ondansetron and ramosetron was documented and compared. Results: One hundred and thirty adult females undergoing lap chole were studied - 65 patients in each of the two groups. In first 24 h after surgery, complete response (No PONV) was observed in 28 patients of the ondansetron group and in 32 patients of the ramosetron group (P>0.05). Complete response in the second 24 h after surgery was observed in 30 patients of the ondansetron group and in 45 patients of the ramosetron group (P<0.05). During the first and second 24 h, PONV requiring rescue antiemetic was significantly higher (P<0.05) in the ondansetron group as compared to the ramosetron group. Adverse drug effects in the post-operative period were observed in 11 and 8 patients in ondansetron and ramosetron groups respectively (P>0.05). Conclusion: Ramosetron was found safe and more effective antiemetic than ondansetron in patients undergoing lap chole.

The Effect of Ondansetron on the Corrected QT Interval of Electrocardiography during General Anesthesia / 대한마취과학회지

BACKGOUND: Prolongation of the corrected QT interval (QTc) has a potential risk of inducing life-threatening cardiac dysrhythmia. Although 5-HT3 antagonists are useful antiemetics, several cases of cardiac dysrhythmia after administration of 5-HT3 antagonists have been reported. Therefore, this study was conducted to evaluate the changes in QTc interval that occur after administration of a clinical dose of ondansetron during general anesthesia. METHODS: Seventy-five patients, who underwent elective surgery under standardized general anesthesia were evaluated. After anesthetic induction, the patients were given either normal saline, 2 mg or 4 mg of iv ondansetron. The QTc on the electrocardiogram was measured immediately prior to administration of the treatment drug and then every minute after injection of the study drug for 10 minutes, 12 and 15 minutes. RESULTS: There were no differences observed in the baseline QTc of the different treatment groups. In addition, there were no significant changes in the QTc interval of the control group, however, the QTc interval was prolonged significantly in both the ondansetron 2 mg and 4 mg groups. Further, DeltaQTc (the difference in QTc interval from the baseline value) was significantly prolonged in the ondansetron 2 mg and 4 mg groups when compared with the control group. There were no differences in the number of patients who showed abnormal QTc and there were no incidences of dysrhythmia in any of the three groups. CONCLUSIONS: Ondansetron administration for emesis prophylaxis during general anesthesia was associated with statistically significant prolongation of the QTc interval. The authors recommend that caution be used when ondansetron is administered to prevent and/or treat postoperative nausea and vomiting, particularly in patients who have a prolonged QTc interval.

The Effect of Ondansetron on the Emergence Agitation after Sevoflurane Anesthesia in Pediatric Patients Undergoing Tonsillectomy / 대한마취과학회지

BACKGROUND: Emergence agitation is a common problem after sevoflurane anesthesia in children. Tropisetron, a 5-HT3 antagonist, significantly reduces the incidence of emergence agitation after sevoflurane anesthesia. This study evaluated the effect of ondansetron on emergence agitation after sevoflurane anesthesia in children undergoing a tonsillectomy. METHODS: Eighty children, aged 3-9 years (ASA physical status I) undergoing tonsillectomy, were randomly enrolled in this study. Group O received 0.1 mg/kg of ondansetron, and group S received 0.1 ml/kg of saline during the operation. Anesthesia was induced with 5 vol% sevoflurane and maintained with 2-2.5 vol% sevoflurane. The agitation score was recorded when they arrived at the postanesthesia care unit, and 10 minutes after that. RESULTS: The incidence of emergence agitation was 30% in group O and 27.5% in group S at arrival (P = 1.00). Ten minutes after arrival, the incidence was 12.5% in group O and 25% in group S (P = 0.25). CONCLUSIONS: Ondansetron 0.1 mg/kg does not reduce the incidence of emergence agitation after sevoflurane in children.