Anesth Analg 2008; 106:1922-
© 2008 International Anesthesia Research Society
doi: 10.1213/ane.0b013e318172c6f1
LETTER TO THE EDITOR
Section Editor:
Lawrence Saidman
Universal PONV Prophylaxis in General Anesthesia: Should We Consider Its Immediate Implementation?
Christian Dürsteler, MD,
Anna Mases, MD, and
Margarita M. Puig, MD, PhD
Anaesthesiology Research Unit; Department of Anaesthesiology; Hospital Universitario del Mar; Universitat Autònoma de Barcelona (UAB); Barcelona, Spain; cdursteler{at}imas.imim.es
To the Editor:
The recently published Guidelines for the Management of Postoperative Nausea and Vomiting1 were accompanied by an Editorial suggesting that, given the high efficacy, low cost, and safety of antiemetics, they should be routinely administered prophylactically to all patients receiving general anesthesia, irrespective of their risk classification.2
On the basis of clinical reports showing that ondansetron could interfere with the postoperative analgesic effect of tramadol,3,4 we conducted animal experiments, to assess if the clinically used antiemetics would interact with tramadol. Our results demonstrated the presence of functional antagonism between the antinociceptive effects of tramadol and ondansetron or droperidol,5 whereas the combination of dexamethasone and tramadol was strongly synergistic.6
Although antiemetics are safe and efficacious drugs, their mechanism of action implicates relevant physiological systems such as pain processing pathways in the CNS. Tramadol induces analgesia by activating µ-opioid receptors and inhibiting norepinephrine and 5-HT reuptake, thus implicating 5-HT3 receptors, which are antagonized by ondansetron to induce the antiemetic effect.
Assuming that the likelihood to develop a pharmacodynamic drug interaction increases exponentially with the number of drugs administered, few drugs are completely innocuous when given perioperatively. We modestly argue that the approval of such a general recommendation should be subject to extensive debate.
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