Apparent Dexmedetomidine-Induced Polyuric Syndrome in an Achondroplastic Patient Undergoing Posterior Spinal Fusion

Abstract

P alonosetron is a new potent 5-hydroxytryptamine 3 (5-HT 3 )antagonist. Although this drug is thought to be more effective in preventing nausea and vomiting in patients receiving opioid-based patient-controlled analgesia (PCA) than other drugs in its class, clinical data are lacking. This study compared the effects of intravenously administered (IV) ondansetron and palonosetron administered at the end of surgery in preventing postoperative nausea and vomiting (PONV) in high-risk patients receiving IV PCA after thyroidectomy.A total of 100 female nonsmoking patients were randomly assigned to a palonosetron group or an ondansetron group. Ondansetron was given as an 8-mg bolus, and 16 mg was added to the IV PCA mixture. In the palonosetron group, 0.075 mg was injected as a bolus only. Fentanyl-based PCA was administered for 24 hours after the surgery. The incidence of PONV, severity of nausea, requirement for rescue antiemetics, and adverse effects were evaluated during 0 to 2 and 2 to 24 hours postoperatively.The incidence of PONV during the 24-hour postoperative interval was lower in the palonosetron group than in the ondansetron group (42% vs 62%, P = 0.045). No differences were observed, however, between the groups during the first 2 hours. Nonetheless, the incidence of PONV and nausea severity were substantially lower in the palonosetron group than in the ondansetron group during 2 to 24 hours (10% with palonosetron compared with 28% with ondansetron, P = 0.02). The investigators concluded that palonosetron is more effective than ondansetron for high-risk patients receiving fentanyl-based PCA after thyroidectomy, especially 2 to 24 hours after surgery.2. Kovac AL, Eberhart L, Kotorski J, et al. A randomized, double-blind study to evaluate the efficacy and safety of three different doses of palonosetron versus placebo in preventing nausea and vomiting over a 72-hour period.