Watcha MF, Anesth 2000; 92-931-3.

Reviewed by: R. Prasad, MD

An editorial accompanying an article by Hill, et.al (which may make it to the site some time) that studied cost-effectiveness of prophylaxis with ondansetron, droperidol, or placebo. Based on this and other studies, a set of guidelines was offered for prophylaxis and treatment of PONV:
Risk           Prophylaxis*    Rescue Tx
Low            None               Ond 1mg or
(<10%)                               Dola 12.5mg
Mild-Mod  Drop 1.25mg         "
(10-30%)
High           Drop 1.25 &          "
(30-60%)    Steroid +/-
                   metoclopramide
Very High  Drop 1.25 &    metoclopramide,
(>60%)       Steroid &          phenothiazine,
                   Ond 8mg or      addtl HT3
                   Dola 12.5mg     antagonist, or
                                            other med
* "PONVprophylaxis with droperidol is less effective than ondansetron in children and is associated with increased drowsiness, delayed discharge, and extrapyramidal side effects. The preferential use of ondansetron in tis patient population may be justified."

Ond = ondansetron
Dola = dolasetron
Drop = droperidol
Steroid = e.g., dexamethasone 1mg/kg, up
               to 8-10mg (my comments)