Nausea and vomiting in the post-anaesthesia period are common and distressing for patients. These symptoms arise from multiple pathways and are influenced by factors such as anaesthetic agents, opioids, patient risk profile and individual physiology. An understanding of antiemetic options helps us tailor therapy for comfort and safe recovery.
The emetic reflex is mediated through several neurotransmitter systems including serotonin (5-HT3), dopamine (D2), histamine (H1), acetylcholine and neurokinin pathways. Different antiemetics target these pathways to prevent and treat nausea and vomiting.
🌟 Key points to remember
🟠 Serotonin 5-HT3 antagonists such as ondansetron are frontline agents for postoperative nausea and vomiting (PONV) and chemotherapy-induced symptoms.
🟠 Dopamine antagonists like droperidol and prochlorperazine are useful but can have sedation and extrapyramidal effects; caution in children.
🟠 Corticosteroids (dexamethasone) enhance antiemetic response when used in combination, especially for PONV.
🟠 Neurokinin-1 antagonists (e.g., aprepitant) are effective for PONV prophylaxis in high-risk patients according to consensus guidelines.
🟠 Antihistamines and anticholinergics may help motion-related nausea or when other pathways are involved.
In recovery, prophylactic and rescue antiemetics improve patient comfort and can reduce complications such as delayed oral intake and prolonged PACU stay. Risk stratification (e.g., history of PONV, female sex, non-smoking status, opioid use) guides the number and type of antiemetics administered.
While individual drugs have benefits and potential adverse effects (e.g., QT prolongation with some serotonin antagonists), a multimodal approach often offers the best balance of effectiveness and minimising side effects in the early postoperative period.
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References:
Athavale, A., Athavale, T. & Roberts, D. M. (2020). Antiemetic drugs: What to prescribe and when. Australian Prescriber, 43(2), 49–56. doi:10.18773/austprescr.2020.011
Australian Society of Anaesthetists. (2021). Australian perspective on Fourth Consensus Guidelines for the management of postoperative nausea and vomiting. Anaesthesia and Intensive Care. doi:10.1177/0310057X211030518
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