scholarly journals Genetic polymorphisms in the cytochrome P450 system and efficacy of 5-hydroxytryptamine type 3 receptor antagonists for postoperative nausea and vomiting

2008 ◽  
Vol 101 (4) ◽  
pp. 441-445 ◽  
Author(s):  
M. Nielsen ◽  
N.V. Olsen
Keyword(s):  
Cytochrome P450 ◽  
Genetic Polymorphisms ◽  
Postoperative Nausea ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Receptor Antagonists ◽  
Cytochrome P450 System ◽  
Type 3

Postoperative Nausea and Vomiting in Patients with Prolonged QTc

2013 ◽  
Author(s):  
Shilpa Rao ◽  
Jerrold Lerman
Keyword(s):  
Postoperative Nausea ◽  
Qt Interval ◽  
Postoperative Nausea And Vomiting ◽  
Torsades De Pointes ◽  
Nausea And Vomiting ◽  
Receptor Antagonists ◽  
Prolonged Qt Interval ◽  
Prolonged Qt ◽  
Type 3 ◽  
Potential Interactions

A panoply of pharmacological and nonpharmacological strategies are currently employed to attenuate the risk of postoperative nausea and vomiting (PONV) in children, including 5-hydroxytryptamine type 3 (5-HT3) receptor antagonists. 5-HT3 receptor antagonists can prolong the QT interval, which can be a precursor of torsades de pointes (TdP), particularly in children with congenital or acquired prolonged QT interval. This chapter summarizes the causes of prolonged QT interval, the potential interactions of prolonged QT interval with antiemetics and anesthetics, and strategies to prevent PONV.

Prolongation of QTc Interval after Postoperative Nausea and Vomiting Treatment by Droperidol or Ondansetron

2005 ◽  
Vol 102 (6) ◽  
pp. 1094-1100 ◽  
Author(s):  
Beny Charbit ◽  
Pierre Albaladejo ◽  
Christian Funck-Brentano ◽  
Mathieu Legrand ◽  
Emmanuel Samain ◽  
...  
Keyword(s):  
Postoperative Nausea ◽  
Low Dose ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Qtc Interval ◽  
Interval Prolongation ◽  
Antiemetic Drug ◽  
Electrocardiographic Monitoring ◽  
Qtc Interval Prolongation ◽  
Type 3

Background At dosages above 0.1 mg/kg, droperidol induces a dose-dependent QTc interval prolongation. Although subject to controversy, low-dose droperidol has recently been suspected to induce cardiac arrhythmias. Hence, 5-hydroxytryptamine type 3 antagonists have become the first-line drug for management of postoperative nausea and vomiting. These drugs are also known to prolong the QTc interval at high dosages. This study describes QTc interval changes associated with postoperative nausea and vomiting treatment by droperidol or ondansetron at low doses. Methods Eighty-five patients with postoperative nausea and vomiting were included in this prospective, single-blind study. Patients received either 0.75 mg intravenous droperidol (n = 43) or 4 mg intravenous ondansetron (n = 42). Electrocardiographic recordings were obtained before administration of antiemetic drug and then 1, 2, 3, 5, 10, and 15 min after. Electrocardiographic monitoring was maintained for 3 h in eight patients in each group. Results The QTc interval was prolonged (> 450 ms in men, > 470 ms in women) in 21% of the patients before antiemetic drug administration. This was significantly correlated with lower body temperature and longer duration of anesthesia. Compared with predrug QTc measurement, both antiemetics were associated with a significant QTc interval prolongation (P < 0.0001). The mean maximal QTc interval prolongation was 17 +/- 9 ms after droperidol occurring at the second minute and 20 +/- 13 ms after ondansetron at the third minute (both P < 0.0001). Compared with predrug measurement, the QTc interval was significantly lower after the 90th minute in both groups. Conclusions Droperidol and ondansetron induced similar clinically relevant QTc interval prolongations. When used in treatment of postoperative nausea and vomiting, a situation where prolongation of the QTc interval seems to occur, the safety of 5-hydroxytryptamine type 3 antagonists may not be superior to that of low-dose droperidol.

scholarly journals A Comparison of Fosaprepitant and Ondansetron for Preventing Postoperative Nausea and Vomiting in Moderate to High Risk Patients: A Retrospective Database Analysis

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Chiaki Murakami ◽  
Nami Kakuta ◽  
Katsuyoshi Kume ◽  
Yoko Sakai ◽  
Asuka Kasai ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Receptor Antagonist ◽  
Postoperative Nausea ◽  
Postoperative Nausea And Vomiting ◽  
Complete Response ◽  
Nausea And Vomiting ◽  
Nk1 Receptor Antagonist ◽  
Risk Patients ◽  
Neurokinin 1 ◽  
Type 3

Postoperative nausea and vomiting (PONV) occur in 30–50% of patients undergoing general anesthesia and in 70–80% of high PONV risk patients. In this study, we investigated the efficacy of fosaprepitant, a neurokinin-1 (NK1) receptor antagonist, compared to ondansetron, a selective 5-hydroxytryptamine type 3 (5-HT3) receptor antagonist, in moderate to high PONV risk patients from our previous randomized controlled trials. Patients (171 patients from 4 pooled studies) with the Apfel simplified score ≥ 2 and undergoing general anesthesia were randomly allocated to receive intravenous fosaprepitant 150 mg (NK1 group, n=82) and intravenous ondansetron 4 mg (ONS group, n=89) before induction of anesthesia. Incidence of vomiting was significantly lower in the NK1 group compared to the ONS group 0–2, 0–24, and 0–48 hours after surgery (2 versus 17%, 2 versus 28%, and 2 versus 29%, resp.). However, no significant differences in PONV, complete response, rescue antiemetic use, and nausea score were observed between groups 0–48 hours after surgery. In moderate to high PONV risk patients, fosaprepitant decreased the incidence of vomiting and was superior to ondansetron in preventing postoperative vomiting 0–48 hours after surgery.

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