Prophylaxis of postoperative nausea and vomiting: controversies in the use of serotonin 5-hydroxytryptamine subtype 3 receptor antagonists.
Postoperative nausea and vomiting (PONV) continues to be a "big little problem" despite recent advances in anesthesia. Because of an increased interest in, and the abundant publications on this topic, guidelines for the management of PONV were published in 2003. Several key but controversial issues regarding PONV prophylaxis were left unaddressed, however. These included whether clinical differences exist between the 5-hydroxytryptamine subtype 3 (5-HT3) receptor antagonists, concern over optimal dosage and timing of administration, optimal 5-HT3 receptor antagonist combination therapy, and whether rescue therapy is effective after prior administration of the same or a different 5-HT3 receptor antagonist. The application of these antiemetics in clinical practice has raised questions regarding the role of the 5-HT3 receptor antagonists in the treatment of postdischarge nausea and vomiting and opioid-induced nausea and vomiting. A brief overview of the incidence, risk factors and current management recommendations for PONV and current controversies with special emphasis on the 5-HT3 receptor antagonists, is discussed.
Kovac
Anthony L
AL
Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS 66160, USA. akovac@kumc.edu
D000701:Analgesics, Opioid / Q000009:adverse effects; D004347:Drug Interactions; D006321:Heart / Q000187:drug effects / Q000502:physiology; D006801:Humans; D015994:Incidence; D007473:Ion Channels / Q000187:drug effects / Q000502:physiology; D008099:Liver / Q000378:metabolism; D020250:Postoperative Nausea and Vomiting / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D044406:Receptors, Serotonin, 5-HT3 / Q000378:metabolism; D012307:Risk Factors; D058831:Serotonin 5-HT3 Receptor Antagonists; D012702:Serotonin Antagonists / Q000627:therapeutic use*
D000701:Analgesics, Opioid; D007473:Ion Channels; D044406:Receptors, Serotonin, 5-HT3; D058831:Serotonin 5-HT3 Receptor Antagonists; D012702:Serotonin Antagonists