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AMBULATORY ANESTHESIA

The Effect of Timing of Dolasetron Administration on its Efficacy as a Prophylactic Antiemetic in the Ambulatory Setting

Xiaoguang Chen, MD^*, Jun Tang, MD^*, Paul F. White, PhD MD, FANZCA^*, Ronald H. Wender, MD, Raymond Quon, Alexander Sloninsky, MD, Robert Naruse, MD, Robert Kariger, MD, Tom Webb, MD, and Eve Norel, MD

*Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas, Texas; and Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, California

Address correspondence and reprint requests to Dr. P. F. White, Professor and McDermott Chair of Anesthesiology, Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd., F2.208, Dallas, TX 75390-9068. Address e-mail to paul.white{at}utsouthwestern.edu

Dolasetron (12.5 mg IV) is effective in both preventing and treating postoperative nausea and vomiting (PONV) after ambulatory surgery. However, the optimal timing of dolasetron administration and its effect on the patient’s quality of life after discharge have not been established. One-hundred-five healthy, consenting women undergoing gynecologic laparoscopic procedures with a standardized general anesthetic technique were enrolled in this randomized, double-blinded study. Group 1 received dolasetron 12.5 mg IV 10–15 min before the induction of anesthesia; Group 2 received dolasetron 12.5 mg IV at the end of the laparoscopy (79 ± 48 min later than Group 1); and Group 3 received dolasetron 12.5 mg IV at the end of anesthesia (93 ± 52 min later than Group 1). The incidence of PONV, complete responses (defined as no emetic episodes and no rescue medication within the 24-h period after anesthesia), recovery profiles, and patient satisfaction were recorded. In the postanesthesia care unit and during the 24-h follow-up period, the incidence of nausea and vomiting, as well as the need for rescue antiemetics, did not differ significantly among the three groups. The percentages of patients with complete responses to the study drug within the first postoperative 24 h were also similar in all three groups (55%, 59%, and 52% for Groups 1, 2, and 3, respectively). The early and intermediate recovery profiles, including resumption of a normal diet and patient satisfaction with the control of PONV, were not different among the three study groups. Dolasetron 12.5 mg IV administered before the induction of anesthesia is as effective as dolasetron given at the end of laparoscopy or at the end of anesthesia in preventing PONV after outpatient laparoscopy.

IMPLICATIONS: The timing of dolasetron administration appears to have little effect on its efficacy when administered as a prophylactic antiemetic in the ambulatory setting.

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