Prophylaxis of postoperative nausea and vomiting in adolescent patients: a review with emphasis on combination of fixed-dose ondansetron and transdermal scopolamine

Abstract

Postoperative nausea and vomiting (PONV) is a relatively common occurrence (20-30%) that delays discharge and, if persistent, can lead to serious complications. The incidence of PONV is a function of patient characteristics, the type and duration of surgery, the type of anesthesia, and the choice of pre-, intra-, and postoperative pharmacotherapy. There are no completely effective antiemetic agents for this condition, but recommendations for treatment strategies are separately available for pediatric and adult patients. Left unclear is whether adolescents should be guided by the pediatric or the adult recommendations. We review the developmental physiology of the relevant physiological factors (absorption, distribution, metabolism, and elimination). We also review the clinical evidence regarding the safety and efficacy of a fixed-dose combination of ondansetron (4 mg, i.v.) and transdermal scopolamine (1.5 mg).

Figure 1

Transdermal scopolamine patch is affixed to skin, where it delivers a priming dose and then a slow release of scopolamine through a special rate-controlling membrane.