title: Granisetron versus ondansetron treatment for breakthrough postoperative nausea and vomiting after prophylactic ondansetron failure: a pilot study.
abstract: BACKGROUND
  Patients with an increased risk of postoperative nausea and vomiting (PONV) are frequently given prophylactic doses of a selective 5-hydroxytryptamine-3 antagonist (5HT3). In chemotherapy patients, it has been demonstrated that after unsuccessful treatment with one 5HT3 administering a different 5HT3 alleviated symptoms. We hypothesized that we could define a benefit of a 5HT3, cross-over in a pilot study of PONV. Two-hundred-fifty female patients received prophylactic ondansetron 4 mg at the end of a surgical procedure requiring general anesthesia and were then followed postoperatively for 4 h.
  
  
  METHODS
  Eighty-eight women developed PONV and were randomly assigned to receive a repeat dose of ondansetron 4 mg (n = 30), granisetron 1 mg (n = 30), or granisetron 0.1 mg (n = 28) and then followed for 24 h.
  
  
  RESULTS
  Patients receiving the repeat dose of ondansetron showed a complete response of 57%. Those receiving 1 or 0.1 mg doses of granisetron had rates of 60% and 68%, respectively. This difference was not statistically significant (P = 0.773).
  
  
  CONCLUSIONS
  Unlike patients with chemotherapy-induced nausea and vomiting, perioperative patients who failed ondansetron prophylaxis did not have a significant response to cross-over dosing with granisetron.
authors.affiliation: Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami School of Medicine, Jackson Memorial Hospital, Miami, Florida 33101, USA. kcandiotti@miami.edu
authors.forename: Keith A
authors.initials: KA
authors.lastname: Candiotti
authors.forename: Fani
authors.initials: F
authors.lastname: Nhuch
authors.forename: Aimee
authors.initials: A
authors.lastname: Kamat
authors.forename: Krisnaprasad
authors.initials: K
authors.lastname: Deepika
authors.forename: Kristopher L
authors.initials: KL
authors.lastname: Arheart
authors.forename: David J
authors.initials: DJ
authors.lastname: Birnbach
authors.forename: David A
authors.initials: DA
authors.lastname: Lubarsky
mesh_terms: D000328:Adult; D018592:Cross-Over Studies; D005260:Female; D017829:Granisetron / Q000008:administration & dosage*; D006801:Humans; D008875:Middle Aged; D017294:Ondansetron / Q000008:administration & dosage*; D010865:Pilot Projects; D020250:Postoperative Nausea and Vomiting / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D013997:Time Factors; D017211:Treatment Failure
chemical_list: D017829:Granisetron; D017294:Ondansetron