Localized Urticaria with Intravenous Ondansetron: A Case Report.

Ondansetron is an eff ective antiemetic agent widely used to control nausea and vomiting associated with malignancy and surgery. Although hypersenstivity reactions have been reported with ondansetron in connection with emetogenic chemotherapy, it has been rarely addressed under perioperative settings. Th is case highlights the need of increased awareness among anaesthesiologists regarding the allergic potential of ondansetron and emphasize for judicious administration of this drug with adequate emergency backup.

Clonidine, doxapram and ondansetron for treatment of postoperative shivering

Postanethetic shivering is a rhythmic movement, predominantly involving the upper limbs, neck and jaw, that occurs in 5-70% of patients recovering from general anesthesia. Postanethetic shivering may produce complications especially in patients with coronary artery disease, secondary to increased oxygen consumption, cardiac output, carbon dioxide production and circulating catecholamines and decrease mixed venous saturation. 60 patients classified as ASA physical status I and II were divided, in recovery room, into 3 groups [n=20] to treat postoperative shivering. Group [1] received clonidine 75 micro g, group [2] doxapeam 60mg and group [3] ondanosetron 8mg Temperature was recorded at the start of surgery, lowest temperature during operation and temperature at the end of surgery. In recovery room shivering score was recorded before drug and 5, 10, 20 and 30min after. Heart rate, mean blood pressure and temperature were measured at arrival, 5, 10, 20, 30, 60 and 90 min after. Side effects as tachycardia, bradycardia, hypertension, hypotension, sedation, persistence of shivering, more than grade II, for more than 5 min and recurrence of shivering after 20 min were recorded. Shivering score, allover the study, decrease significantly in group [1] compared to group [2] and [3], also decrease in group [2] compared to group [3]. Hypotension, bradycardia and sedation were associated with clonidine. Hypertension and tachycardia were associated with doxapram. Persistence of shivering was more in group [3] while reoccur of shivering was more in group [2]. Clonidine, doxapram and ondanosetron can be used to treat postoperative shivering, but clonidine is superior to doxapram and ondanosetron. Side effects of clonidine like hypotension, bradycardia and sedation must be in consideration especially in haemodynamically instable patients. Doxapram can be used in hypotensive patients, but avoid it if there is hypertension or tachycardia. On the other side ondanosetron has innocuous effects on the cardiovascular system. Persistence of shivering is more with ondanosetron while reoccurs, after 20min, is more with doxapram

Ondansetron vs metoclopramida para la profilaxis de náusea y vómito postoperatorio después de cirugía abdominal / Ondansetron versus metoclopramida for the náusea prophylaxis and postoperating vomit after abdominal surgery

Una gran incidencia de náusea y vómito postoperatorio (NVPO) es reportada en pacientes programados pra cirugía abdominal. Este estudio fue realizado para comparar la eficacia de ondansetrón versus metoclopramida en la prevención de NVPO en pacientes sometidos a anestesia general para cirugía abdominal. Se realizó un estudio clínico, experimental, randomizado, simple ciego, en 60 pacientes de ambos sexos divididos en dos grupos de 30 cada uno, entre 15 y 64 años, clasificados con estado físico ASA I, II, III, que recibieron en forma aleatoria 4mg IV de ondansetrón (grupo A) y 10 mg IV de metoclopramida (grupo B) cinco minutos antes de la finalización de la cirugía. La misma técnica de anestesia general fue utilizada la cual consistió en fentanylo, tiopental, vecuronio, ethrane y oxígeno. Se revirtió el bloqueo neuromuscular con prostigmine y atropina. La náusea y el vómito así como los efectos adversos de éstas drogas, tensión arterial, frecuencia cardíaca se valoraron continuamente durante las primeras seis horas después de la cirugía. Se estableció además la relación entre sexo, tipo de cirugía (electiva o de urgencia), procedimiento (abierto o laparoscópico), diagnóstico (patología gastrointestinal o ginecológica), tiempo anestésico y náusea y vómito. La náusea fue valorada por una escala objetiva de 0 a 3, y el vómito por el número de presentación. El análisis estadístico fue realizado usando test de chi cuadrado para las variables cualitativas y test de comparación proporcional, de medias y de varianza para las variables cuantitativas. La incidencia de NVPO fue igual con ondansetrón y con metoclopramida, sin existir diferencia significativa (pNS). Se registró una disminución de la frecuencia cardíaca mayor con metoclopramida que con ondansetrón a las cuatro horas posteriores a la cirugía (p 0.005). Las mujeres presentaron una tendencia mayor a la náusea que los varones (p 0.19). Para los otros parámetros no se estableció ninguna diferencia estadísticamente significativa. Concluimos en este estudio que ondansetrón y metoclopramida son igualmente efectivos como profilácticos en el control de NVPO durante las primeras seis horas de postoperatorio.

Preliminary experience with use of a selective 5HT3 receptor antagonist (ondansetron) to prevent high dose chemotherapy induced emesis.

Ondansetron was used as an antiemetic along with dexamethasone during 16 cycles of highly or moderately ematogenic chemotherapy. There was major control in two cycles and complete control in the remaining 14. Side effects were minor and did not require discontinuation of the drug. This combination, therefore, appears to be safe and effective in preventing chemotherapy induced emesis.