Postoperative nausea and vomiting (
PONV) are distressing and frequent adverse events of
anesthesia and surgery, with a relatively high incidence after
laparoscopic cholecystectomy. Numerous
antiemetics have been studied for the prevention and treatment of
PONV in patients scheduled for
laparoscopic cholecystectomy. Traditional
antiemetics, including
anticholinergics (e.g.,
scopolamine),
antihistamines (e.g.,
dimenhydrinate),
phenothiazines (e.g.,
promethazine),
butyrophenones (e.g.,
droperidol), and
benzamide (e.g.,
metoclopramide), are used for the control of
PONV. The available nontraditional
antiemetics for the prophylaxis against
PONV are
dexamethasone and
propofol.
Serotonin receptor antagonists (
ondansetron,
granisetron,
tropisetron,
dolasetron, and
ramosetron), compared with traditional
antiemetics, are highly efficacious for
PONV. The prophylactic
ondansetron,
granisetron,
tropisetron, and
dolasetron in
antiemetic efficacy are comparable.
Ramosetron is effective for the long-term prevention of
PONV. None of the available
antiemetics is entirely effective, perhaps because most of them act through the blockade on one type of receptor. There is a possibility that combined
antiemetics with different sites of activity would be more effective than one
drug alone for the prophylaxis against
PONV. Combination
antiemetic therapy is often effective for the prevention of
PONV following
laparoscopic cholecystectomy. The efficacy of a combination of
serotonin receptor antagonists (
ondansetron and
granisetron) and
droperidol is superior to monotherapy with a
serotonin receptor antagonist or
droperidol. Similarly, adding
dexamethasone to
ondansetron or
granisetron improves
antiemetic efficacy in
PONV. Knowledge regarding
antiemetics is necessary to completely prevent and treatment of
PONV in patients scheduled for
laparoscopic cholecystectomy.