Timing of administration of dolasetron affects dose necessary to prevent postoperative nausea and vomiting.
OBJECTIVE
To determine if the timing of administration affects the dose of dolasetron necessary to prevent postoperative nausea and vomiting (PONV).


METHODS
Pooled data from 8 randomized, multicenter, double-blind, placebo-controlled studies with common endpoints.


METHODS
University hospital.


METHODS
A total of 4,587 ASA physical status I, II, and III patients, including 4,124 females undergoing primarily gynecologic procedures and 463 males undergoing various procedures (i.e., thyroidectomy or orthopedic, ophthalmologic, urologic, ENT, or laparoscopic surgery).


METHODS
Balanced general anesthesia was used during all procedures. Patients received a dose of dolasetron either for prevention of PONV (25 or 50 mg IV at induction; 25, 50, 100, or 200 mg orally 1 to 2 hours pre-induction; or 12.5, 25, 50, or 100 mg IV at end of anesthesia) or for treatment of PONV (12.5, 25, 50, or 100 mg IV). One PONV prevention study had an ondansetron (comparator) group.


METHODS
Outcome measures over a 24-hour study period included complete response (defined as no vomiting/retching and no need for rescue medication), percentage of patients without nausea [defined as nausea visual analog scale (VAS) score < 5 mm], and maximum nausea according to VAS score.


RESULTS
A 12.5-mg IV dose of dolasetron resulted in a complete response rate that was statistically significantly higher than placebo and comparable to higher dolasetron doses (25 mg to 100 mg IV) when administered either near the end of anesthesia for prevention of PONV or at the onset of symptoms for treatment of PONV. In contrast, when administered at induction of anesthesia, a statistically significant treatment response was observed with dolasetron 50 mg IV, but not at a lower dose.


CONCLUSIONS
When dosed near the end of anesthesia, a 12.5 mg IV dose of dolasetron was comparable to higher doses administered at or before induction of anesthesia.
Korttila
Kari T
KT
Department of Anesthesia and Intensive Care, Haartmaninkatu 2, University of Helsinki, Helsinki, Finland. kari.korttila@hus.fi
Jokinen
Jeremy D
JD
D000328:Adult; D000932:Antiemetics / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007211:Indoles / Q000008:administration & dosage* / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control*; D011807:Quinolizines / Q000008:administration & dosage* / Q000494:pharmacology; D012702:Serotonin Antagonists / Q000008:administration & dosage*; D013997:Time Factors
D000932:Antiemetics; D007211:Indoles; D011807:Quinolizines; D012702:Serotonin Antagonists; C060344:dolasetron