3 6 S U P P L E M E N T T O O U T P A T I E N T S U R G E R Y M A G A Z I N E J U LY 2 0 1 6
ondansetron with droperidol
or dexamethasone are the
most often studied. To
reduce PONV risk by 25%,
try this one-two punch —
give dexamethasone 4 mg at
induction, and ondansetron
4 mg and droperidol 1.25 mg
at the end of surgery.
Using 5-HT3 receptor
antagonists with dexametha-
sone or droperidol, or
droperidol combined with
dexamethasone, outperforms use of either drug alone. The combinations of 5-
HT3 receptor antagonists plus droperidol, 5-HT3 receptor antagonists plus dex-
amethasone, and droperidol plus dexamethasone are similarly effective in reduc-
ing PONV.
Droperidol, which is similar to many 5-HT3 antagonists, has an FDA black
box warning regarding its potential to prolong QT interval. Although its efficacy
has been proven, it's not commonly used due to the black box warning and is in
short supply.
A multimodal approach involving 2 or more interventions is most effective in
high-risk patients. For example, opt for regional or TIVA with propofol over gener-
al anesthesia. Also administer antiemetic agents from different classes to optimize
their effects.
If patients fail to respond to the action of a primary antiemetic, switch to
another agent with a different mechanism of action. If they haven't received pro-
phylactic antiemetic therapy, treat vomiting with the oral NK-1 receptor antago-
nist aprepitant and nausea with the 5-HT3 receptor antagonists ramosetron and
palonosetron.
Pamela
Bevelhymer,
RN,
BSN
• STICK TO IT Scopolamine patches offer effective prophylactic effects, especially in
the outpatient setting.
