<p>Perioperative Administration of Emend^® (Aprepitant) at a Tertiary Care Children’s Hospital: A 12-Month Survey</p>

Abstract

IntroductionAprepitant (Emend®) is a novel antiemetic agent that works through antagonism of neurokinin-1 (NK-1) receptors. To date, there are limited data regarding its use to prevent postoperative nausea and vomiting (PONV) in children. We retrospectively reviewed our initial 12-months experience with aprepitant after it was made available for perioperative use.MethodsThe anesthetic records of patients who received aprepitant were retrospectively reviewed and demographic, surgical, and medication data retrieved.ResultsThe study cohort included 31 patients (15 male and 16 female) ranging in age from 4 to 27 years (15.7 ± 7.4 years) and in weight from 14.4 to 175.7 kilograms (59.3 ± 30.2 kgs). Most of the patients (30 of 31) received the capsule form and 1 received the liquid. The average dose of aprepitant administered was 0.9 ± 0.6 mg/kg; however, only one patient received dosing expressed as mg/kg, and the majority received a 40 mg capsule. All of the patients in the cohort had either a previous history of PONV or risk factors for PONV. PONV occurred in the PACU in 1 patient and during the first 24 postoperative hours in 3 additional patients. No adverse effects related to aprepitant use were noted.ConclusionAprepitant was easily added to the preoperative regimen for pediatric patients who may require it. Our approach limited overuse and subsequent cost concerns. Future studies with a comparator group and a greater sample size are needed to demonstrate its efficacy, especially in comparison to time-honored agents such as ondansetron. No adverse effects were noted in our limited study cohort.

Mechanisms of Nausea and Vomiting: Current Knowledge and Recent Advances in Intracellular Emetic Signaling Systems

“…Prevention: The NK 1 receptor antagonist aprepitant exerts improved antiemetic efficacy against both acute and delayed PONV, when compared with the 5-HT 3 receptor antagonist ondansetron [ 168 ]. In patients with moderate to high risk of developing PONV, a combination of prophylactic antiemetic drugs with different mechanisms of action has been recommended [ 163 ].…”

Preoperative Management of Gastrointestinal and Pulmonary Medications: Society for Perioperative Assessment and Quality Improvement (SPAQI) Consensus Statement

“…It is well tolerated and has been found to be safe and effective in the perioperative setting. 30 Concurrent use of aprepitant with opioids, midazolam, alprazolam, or triazolam can increase risk of respiratory depression and opioid toxicity, but this is less of a concern if a single dose is used. It has also been reported to decrease the efficacy of oral contraceptive medications for up to 28 days; it is important to mention to women that an alternative form of contraception should be used for 1 month after the last dose of aprepitant.…”

Preoperative Administration of Aprepitant to Prevent Postoperative Nausea and Vomiting in Children

“…It has also been used with increasing frequency to prevent PONV in the adult and pediatric population [15,-19]. In a prior study at our tertiary care children's hospital, we described our initial 12-month experience with the administration of aprepitant in the perioperative scenario following its introduction to our perioperative hospital formulary in a cohort of 31 pediatric patients [20]. The current study expands on that experience, outlining the preoperative use of aprepitant in a larger cohort of children, adolescents, and young adults in our tertiary care children's hospital.…”