Ondansetron

[seamonkey]

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hypothetical question:

A young woman (40 something years old) in for a mastectomy, free flap.
Says ondansetron "does not work for her".

Without any other info (i dunno, maybe says she had it once before and it didn't improve her nausea), would you still give it to her at the end of the case? Why? Why not?

 

[bigeyedfish]

If I didn't give it to her, it wouldn't be because she says it didn't work on her once. Zofran works better to prevent nausea rather than treat it in my experience.

 

[InductionAgent]

hypothetical question:

A young woman (40 something years old) in for a mastectomy, free flap.
Says ondansetron "does not work for her".

Without any other info (i dunno, maybe says she had it once before and it didn't improve her nausea), would you still give it to her at the end of the case? Why? Why not?

A lot of anesthesia practitioners use ondansetron as a sole antiemetic, and thus it often fails.

Unless I could give her a big gun like Emend, I would still give her a 5HT3 antagaonist as part of a more aggressive regimen. I would choose granisetron or dolasetron, so that I could still honestly say that I did not give her ondansetron. Barring contraindications I would also give her dexamethasone and either promethazine or droperidol to complete the 3-drug prophylaxis recommended in a high-risk patient.

 

[proman]

Interestingly enough, ondansetron is more effective at anti-vomiting than anti-nausea. That's one reason why patients who have 2 to 3 risk factors should be given more than 1 drug of different classes to prevent PONV. She has at least 3 risk factors (female, history of PONV, postop opioids, ? nonsmoker). I'd give her transdermal scopolamine preop, dexamethasone at induction, dolasetron (instead of ondansetron) 30 min prior to end of anesthesia. If she were scheduled to go home, I'd include promethazine, 6.25mg.

 

[Mman]

A lot of anesthesia practitioners use ondansetron as a sole antiemetic, and thus it often fails.

Unless I could give her a big gun like Emend, I would still give her a 5HT3 antagaonist as part of a more aggressive regimen. I would choose granisetron or dolasetron, so that I could still honestly say that I did not give her ondansetron. Barring contraindications I would also give her dexamethasone and either promethazine or droperidol to complete the 3-drug prophylaxis recommended in a high-risk patient.

Is Emend a "big gun" or just an expensive gun? I seem to recall the NNT was similar to other anti-emetics.

For pukers, my usual regimen is preop H2 blocker + dexamethasone along with intra-op ondansetron. Will add in scop patch if they have hx of motion sickness and perhaps TIVA if they really have a bad history.

 

[jwk]

Decadron, benadryl, I'd still give the ondansetron (we don't carry the others, nor drop), plenty of IV fluid, pent, sux, tube. OK, sorry, got carried away on the last three. If she still pukes, tell her it's the will of God, and she's just one of those people who's going to puke regardless.

 

[penghill]

Tropisetron works better, why not try

 

[deleted126335]

hypothetical question:

A young woman (40 something years old) in for a mastectomy, free flap.
Says ondansetron "does not work for her".

Without any other info (i dunno, maybe says she had it once before and it didn't improve her nausea), would you still give it to her at the end of the case? Why? Why not?

I would say to the patient "that unless you object I would still like to give you Zofran in addition to other measures"

 

[ssmallz]

hypothetical question:

A young woman (40 something years old) in for a mastectomy, free flap.
Says ondansetron "does not work for her".

Without any other info (i dunno, maybe says she had it once before and it didn't improve her nausea), would you still give it to her at the end of the case? Why? Why not?

Do you still give patients fentanyl w/a codeine allergy?

 

[jennyboo]

hypothetical question:

A young woman (40 something years old) in for a mastectomy, free flap.
Says ondansetron "does not work for her".

Without any other info (i dunno, maybe says she had it once before and it didn't improve her nausea), would you still give it to her at the end of the case? Why? Why not?

Yes. I'd slap on a scopolamine patch with handwashing instructions, then while she's asleep give her 2-3 more agents. Ondansetron would be one of them.

They get a TIVA if I am feeling unusually nice, otherwise they get the same volatile as everyone else. If you puke with 4 antiemetics I'm not sure adding a fifth antiemetic-equivalent will stop you from puking.

I tell pukers that, hypothetically, if each drug reduces PONV by 25%, four of them added up does not equal 100% -- it's like 25% off coupons, when you put four of them together you don't get a freebie. If they puke again, they can't say I didn't tell them.