Antiemetic of choice for an aeromedical paediatric retrieval team Name of the student Health sciences and medicine Name of the professor July 23, 2012 You are the Medical Director for an aeromedical paediatric retrieval team staffed by critical care paramedics…
In addition, the underlying disease process itself, such as gastroenteritis, chemotherapy or a perioperative state of the patient may mandate use of antiemetics (Antonarakis & Hain, 2004; Bolton, Myles, Carlin & Nolan, 2007; Levine, 2009). Various groups of antiemetics such as antihistamines (promethazine, dimenhydrinate), 5-HT3 receptor antagonists (Ondansetron), dopamine antagonists (metoclopramide, domperidone), anticholinergics (hyoscine, scopolamine) etc have been studied in the adult population and have well documented and evidence based indications and adverse effects (Enarson, Gouin & Goldman, 2011). However, as most of these medications have side effects in children, they are either not recommended in children or are not licensed for paediatric use (Harris C, Wilkinson F, Mazza D, Turner T, 2008). Despite this, antiemetics are routinely prescribed for paediatric nausea and vomiting (Manteuffel, 2009). In motion sickness, labyrinthine mediated pathways are very effectively abolished by antihistamines and anticholinergics. Therefore, these are very effective as prophylaxis against motion sickness in adults. Nevertheless, adverse effects of these drugs are not acceptable in paediatric patient population and thus 5 HT3 antagonists, despite being less effective, are far safer to use in this age group. Ondansetron, the representative and first drug of 5 HT3 receptor antagonist group has been used in paediatric patients for quite some time now and no serious adverse effects have been noted (Apfel, 2010; Cohen, 2007). It is one of the most common drugs used for paediatric emergency department nausea and vomiting (Mee, Egerton-Warburton & Meek, 2011). Moreover, its efficacy in chemotherapy and radiation induced vomiting and postoperative nausea and vomiting is well proven. This article will discuss ondansetron as the drug of choice in motion induced and other causes of nausea and vomiting in an aeromedical paediatric retrieval team. Pathophysiology of emesis The basic mechanism for induction of emesis is stimulation of vomiting centre present in the medulla which is done by various neurotransmitters such as serotonin, dopamine, histamine, acetylcholine and neurokinin (NK1). These neurotransmitters act at various receptors located at chemoreceptor trigger zone (CTZ), gastrointestinal tract, vestibular apparatus and cerebrum, which transmit information to vomiting centre via vagus nerve. CTZ itself can be stimulated chemically or through vagus nerve. Thus, central or peripheral stimulation via complex neural and humoral mechanism, leads to nausea and vomiting (Cohen, 2007). Motion sickness particularly results from afferents from vestibular apparatus and is a risk factor predictive of postoperative and chemotherapy induced vomiting (Antonarakis & Hain, 2004). Therefore, Ondansetron, which is effective for post operative and chemotherapy induced vomiting, must be effective as corollary in the management of motion sickness, although Golding & Gresty (2005) mentioned in their review on motion sickness that Ondansetron is not effective in motion sickness. Ondansetron: Basic pharmacology Ondansetron is a selective antagonist at the serotoninergic 5HT3 receptors present at the vagus nerve and CTZ. Oral bioavailability is good and half life in plasma is 4 hours. The drug is well absorbed and extensively metabolised in the body. Its ...
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