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)