USE OF ONDANSETRON FOR CONTROL OF PROJECTILE VOMITING IN PATIENTS WITH NEUROSURGICAL TRAUMA - 2 CASE-REPORTS

OBJECTIVE: To describe two cases of projectile vomiting that were trea ted successfully with ondansetron in patients with neurosurgical traum a. Causes and pharmacologic treatments for nausea and emesis are also discussed. DATA SOURCES: Patient data and literature citations from pu blished case reports, review articles, and clinical research reports a s identified by MEDLINE. DATA SYNTHESIS: Ondansetron, a potent and hig hly selective antagonist of serotonin at the 5-HT3 (subtype 3)-recepto r, possesses potent antiemetic effects. It has not been associated wit h the extrapyramidal adverse effects seen with traditional antiemetics . The occurrence of extrapyramidal reactions may limit the usefulness of conventional antiemetics in neurosurgical patients because such age nts interfere with serial mental status examinations and lower the sei zure threshold. Therefore, ondansetron may be preferable in this patie nt population. Two patients with head trauma and projectile vomiting w ere treated successfully with ondansetron following treatment failure with prochlorperazine. These represent the first reported cases of eff icacious treatment with ondansetron in neurosurgical trauma patients. CONCLUSIONS: Ondansetron may be the preferred agent for controlling na usea and vomiting in patients with neurosurgical trauma. Controlled cl inical trials are needed to evaluate its safety and efficacy in this p atient population.