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Department of Anesthesiology, Mount Sinai Medical Center, New York, NY, steve.neustein{at}msnyuhealth.org
To the Editor:
Gan et al. (1) recently reported that in patients receiving 8 mg of dexamethasone at induction of anesthesia, a pre-extubation dose of 0.1 mg of granisetron was as effective as a pre-extubation dose of 4 mg of ondansetron for preventing vomiting during the first 2 h after extubation. I would like to share our experience with this regimen.
In an effort to reduce pharmacy costs, we introduced a program of small-dose granisetron prophylaxis, exactly as described in the recent study. A physician sponsored by Roche (Nutley, NJ) provided instruction on the use of small-dose (0.1 mg) Kytril (granisetron) and dexamethasone 8 mg, exactly the regimen in the recent study. The pharmacy prepared syringes of 0.1 mg granisetron, which were signed out with no limitation or accounting of how many syringes physicians received. Ondansetron was no longer available.
It appeared clinically that there was an increased incidence of nausea and vomiting in the postanesthesia care unit, and physicians began to administer multiple doses of granisetron. It is possible that it was not being used in conjunction with dexamethasone in some of these cases. However, pharmacy costs increased rather than decreased. The program was terminated and vials of 4 mg of ondansetron were reintroduced.
Our efforts preceded this study. Had this study been available to us, perhaps physicians would be more inclined to use the combination recommended by Gan et al. (1) and avoid multiple doses of granisetron. However, the proposed regimen was not successful. Another consideration is that ondansetron will be available as a generic drug in 2006.
Reference
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