Current therapy for management of postoperative nausea and vomiting: the 5-HT3 receptor antagonists

The control of postoperative nausea and vomiting (PONV) remains a problem in spite of the improvements achieved with newer anesthetic agents, such as propofol, and newer antiemetics. Management of PONV is difficult, this is most likely due to the multiple receptors and neurotransmitters in the central nervous system that mediate the emetic response, and to the multifactorial etiology of PONV. Studies of the four major 5-hydroxytryptamine (serotonin) subtype-3 (5-HT₃) receptor antagonists suggest that they have similar safety and efficacy for prevention and treatment of PONV. These drugs lack the significant side effects observed with traditional antiemetics. Combination regimens of 5-HT₃ receptor antagonists and traditional antiemetics can improve antiemetic efficacy. Areas of future study include comparing the cost effectiveness of these agents and determining optimal combinations of antiemetics to further reduce the incidence of PONV.