Miscellaneous anti-emetic agents

Steroids (e.g. dexamethasone)

• Single dose is NOT associated with
  * Delayed wound healing
  * Cushing's syndrome
• Inexpensive

Mode of action

• UNCERTAIN
• A few possible hypothesis
  * Decreases serotonin release in CNS and periphery
  * Inhibits prostagladin synthesis

 

Side effect

Perineal pain (rare)

 

Dosage

Adult dose

• 8-12mg
• 5mg as effective as 2mg tropisetron for lap cholecystectomy, thyroidectomy, LSCS
• NNT = 7

Paediatric dose

• 150mcg/kg
• NNT=4 for tonsillectomy

 

Midazolam

• Short-acting benzodiazepine

Possible anti-emetic property

• Exact mechanism unknown
• Possible mechanisms include enhencing GABA and inhibition of dopamine release

 

Study: European Academy of Anaesthesiology, Vol21(1), Jan 2004, pp60-65

• Single dose of 1mg successfully treated PONV in 56.7 of patients
• Second dose of 1mg success rate = 93%
• Single dose of 2 mg success rate = 83.4%

 

Others

Include

• Acupuncture
• Cannabinoids
• Neurokini-1 antagonists (new)
• Ginger
• Ephedrine
• Intraoperative IV fluid (in preventing PONV)