title: Antiemetic prophylaxis for office-based surgery: are the 5-HT3 receptor antagonists beneficial?
abstract: BACKGROUND
  Office-based surgery has become increasingly popular because of its cost-saving potential. However, the occurrence of postoperative nausea and vomiting (PONV) can delay patient discharge. Prophylaxis using a combination of antiemetic drugs has been suggested as an effective strategy for minimizing PONV. The authors designed this randomized, double-blinded, placebo-controlled study to assess the efficacy of ondansetron and dolasetron when administered in combination with droperidol and dexamethasone for routine antiemetic prophylaxis against PONV in the office-based surgery setting.
  
  
  METHODS
  Following institutional review board approval, 135 consenting outpatients with American Society of Anesthesiologists physical status I-III who were undergoing superficial surgical procedures lasting 20-40 min were randomly assigned to one of three antiemetic treatment groups. Propofol was administered for induction of anesthesia, followed by 2-4% desflurane with 67% nitrous oxide in oxygen. Desflurane was subsequently adjusted to maintain a clinically adequate depth of anesthesia with an electroencephalographic Bispectral Index value between 50 and 60. All patients received 0.625 mg intravenous droperidol and 4 mg intravenous dexamethasone after induction of anesthesia. The study medication, containing normal saline (control), 12.5 mg intravenous dolasetron, or 4 mg intravenous ondansetron, was administered prior to the end of surgery. All patients received local anesthetics at the incisional site and 30 mg intravenous ketolorac to minimize postoperative pain. Recovery profiles, incidence of PONV, requirement for rescue antiemetic drugs, complete response rates, and patient satisfaction were assessed.
  
  
  RESULTS
  The recovery times to patient orientation, oral intake, ambulation, and actual discharge did not differ among the three groups. The incidence of PONV, nausea scores, and requirement for rescue antiemetics were also similar in all three groups during the 24-h study period. In addition, the complete response rates to the prophylactic antiemetics (96-98%) and percentages of very satisfied patients (93-98%) were equally high in all three groups. However, the antiemetic drug acquisition costs were US $2.50, $15.50, and $18.50 in the control, dolasetron, and ondansetron groups, respectively.
  
  
  CONCLUSIONS
  The addition of dolasetron (12.5 mg) or ondansetron (4 mg) failed to improve the antiemetic efficacy of droperidol (0.625 mg intravenous) and dexamethasone (4 mg intravenous) when they were used for routine prophylaxis in the office-based surgery setting.
authors.affiliation: University of Texas Southwestern Medical Center at Dallas, 75390, USA.
authors.forename: Jun
authors.initials: J
authors.lastname: Tang
authors.forename: Xiaoguang
authors.initials: X
authors.lastname: Chen
authors.forename: Paul F
authors.initials: PF
authors.lastname: White
authors.forename: Ronald H
authors.initials: RH
authors.lastname: Wender
authors.forename: Hong
authors.initials: H
authors.lastname: Ma
authors.forename: Alexander
authors.initials: A
authors.lastname: Sloninsky
authors.forename: Robert
authors.initials: R
authors.lastname: Naruse
authors.forename: Robert
authors.initials: R
authors.lastname: Kariger
authors.forename: Tom
authors.initials: T
authors.lastname: Webb
authors.forename: Alan
authors.initials: A
authors.lastname: Zaentz
mesh_terms: D000368:Aged; D000556:Ambulatory Surgical Procedures; D000932:Antiemetics / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007211:Indoles / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D017294:Ondansetron / Q000627:therapeutic use; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control*; D011229:Preanesthetic Medication; D011807:Quinolizines / Q000627:therapeutic use; D011985:Receptors, Serotonin / Q000187:drug effects; D044406:Receptors, Serotonin, 5-HT3; D012702:Serotonin Antagonists / Q000627:therapeutic use*
chemical_list: D000932:Antiemetics; D007211:Indoles; D011807:Quinolizines; D011985:Receptors, Serotonin; D044406:Receptors, Serotonin, 5-HT3; D012702:Serotonin Antagonists; D017294:Ondansetron; C060344:dolasetron