Letters to the Editor
Thank you for the opportunity to answer the questions by a reader of Anesthesia & Analgesia. As previously described in the first report by us (1), we evaluated the efficacy and safety of granisetron, a selective 5-hydroxytryptamine Type 3 (5-HT3) receptor antagonist, for preventing postoperative nausea and vomiting (PONV) in women undergoing major gynecologic surgery. Consequently, granisetron was effective for the control of PONV after major gynecologic surgery, with little adverse event. Since then, we have investigated to assess the prophylactic antiemetic therapy with granisetron for preventing PONV after various types of surgery, such as pediatric tonsillectomy, breast surgery, middle ear surgery, and thyroidectomy, with a relatively high incidence of PONV when no prophylactic antiemetic is given.
Granisetron lacks the sedative, dyspholic, and extrapyramidal symptoms associated with non-5-HT3 receptor antagonist (e.g., droperidol, metoclopramide) (2,3). Mild headache occurs in patients receiving granisetron for preventing chemotherapy-induced emesis (4). Similarly, in a number of our studies regarding granisetron and PONV, we found that several patients who had received granisetron experienced mild headache and that an incidence of headache was approximately 10%. Consequently, an incidence of headache seems to be identical, but it was true. How much evidence is required to provide adequate proof about antiemetics’ adverse events introduced recently by several investigators?
Yoshitaka Fujii, MD
1. Fujii Y, Tanaka H, Toyooka H. Reduction of postoperative nausea and vomiting with granisetron. Can J Anaesth 1994; 41:291–4.
2. Watcha MF, White PF. Postoperative nausea and vomiting: its etiology, treatment, and prevention. Anesthesiology 1992; 77:162–84.
3. Yarker YE, McTavish D. Granisetron: an update of its therapeutic use in nausea and vomiting induced by antineoplastic therapy. Drugs 1994; 48:761–93.
4. Falkson G, vanZyl AJ. A phase I study of a new 5HT3
receptor antagonist, BRL 43694A, an agent for the prevention of chemotherapy-induced nausea and vomiting. Cancer Chemother Pharmacol 1989; 24:193–6.