ANESTHESIOLOGY FAST REVIEW

ANESTHESIOLOGY_FAST_REVIEWKAPAK1-0-25

OTHER AGENTS IN ANESTHESIOLOGY PRACTICE

Özlem Kapusuz Körduman

Dr. Sami Ulus Obstetrics, Gynecology, Pediatrics Training and Research Hospital, Department of Anesthesiology and Reanimation, Ankara, Türkiye

Kapusuz Körduman Ö. Other Agents in Anesthesiology Practice. In: Kazancı D, editor. Anesthesiology Fast Review. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.171-184.

ABSTRACT

  • Although significant progress has been made in understanding target receptor function and developing new antiemetic agents, the exact mechanisms underlying postoperative nausea and vomiting (PONV are still unknown).
  • Ondansetron is the most frequently used 5HT3 receptor antagonist for preventing and treating PONV and chemoterapy ınduce nausea and vomiting (CINV), likely due to its lack of sedative effects,which could otherwise delay recovery from anesthesia.
  • Low dose droperidol (0-625-1.25 mg), a D2 (type 2) receptor antagonist, was once the most commonly used antiemetic for PONV prevention. However, concers regarding its potential to cuase torsades de pointes and cardiac arrest, the food and drug administration (FDA) issued a black box warning, leading to a significant decline in its use in the United States.
  • Metoclopramide serves as an alternative D2 receptor blocker, with 25 mg being the minimum effective dose for PONV prevention. While extrapyramidal symptoms occur in less than 1% of patients at this dosage, it has been linked to arrhythmias, similar to other D2 antagonists.
  • The antiemetic properties of glucocorticoids, such as dexamethasone, are well recognized, through their exact mechanism remains unclear. Research on dose response suggests that 4 mg is the minmum effective dose, providing efficacy comparable to 4 mg of ondansetron and 1.25 mg of droperidol
  • Aprepitant is the first NK1 receptor antagonist approve by the FDA. A 40 mg oral dose decreases nausea by around 30% and vomiting by more than 50%. Therefose, it is particularly useful in surgeries where postoperative vomiting may influence surgical success.
  • Transdermal skopolamine (TDS) is the sole approved anticholinergic for preventing PONV. Its risk reduction rate (RRR) is similar to other antiemetic, and its prolonged duration of action makes it suitable option for PONV prevention in ambulatory patients.

Keywords: Antiemtics; Pharmacology; Postoperative nausea and vomiting

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