Despite advances in antiemetics and protocolized postoperative nausea vomiting (PONV) management, it remains one of the most common postoperative adverse events. In patients who developed PONV despite antiemetic prophylaxis, giving a rescue treatment from the same class of medication is known to be of limited efficacy. Given the widespread use of 5-HT3 antagonists as PONV prophylaxis, another class of effective intravenous rescue antiemetic is in dire need, especially when prophylaxis fails, and rescue medication is utilized. Dopamine antagonists were widely used for the treatment of PONV but have fallen out of favor due to some of their side effect profiles. Amisulpride was first designed as an antipsychotic medication but was found to have antiemetic properties. Here we will review the historical perspective on the use of dopamine receptor antagonist antiemetics, as well as the evidence on the efficacy and safety of amisulpride.

BACKGROUND: Cholinesterase inhibitors, such as neostigmine and edrophonium, commonly used to reverse the residual effects of nondepolarizing neuromuscular blocking drugs at the end of surgery are associated with a high rate of residual neuromuscular blockade (NMB). Due to its direct mechanism of action, sugammadex is associated with rapid and predictable reversal of deep NMB. The current analysis compares the clinical efficacy and risk of postoperative nausea and vomiting (PONV) on using sugammadex or neostigmine for routine NMB reversal in adult and pediatric populations.
METHODS: PubMed and ScienceDirect were searched as the primary databases. Randomized controlled trials comparing sugammadex with neostigmine for routine NMB reversal in adult and pediatric patients have been included. The primary efficacy endpoint was the time from initiation of sugammadex or neostigmine to the recovery of a time-of-four ratio (TOF) ≥ 0.9. PONV events have been reported as secondary outcomes.
RESULTS: A total of 26 studies have been included in this meta-analysis, 19 for adults with 1574 patients and 7 for children with 410 patients. Sugammadex, when compared to neostigmine, has been reported to take a shorter time to reverse NMB in adults (mean difference = -14.16 min; 95% CI [-16.88, -11.43], P < 0.01), as well as in children (mean difference = -26.36 min; 95% CI [- 40.16, -12.57], P < 0.01). Events of PONV have been found to be similar in both the groups in adults, but significantly lower in children treated with sugammadex, i.e., 7 out of 145 with sugammadex versus 35 out of 145 with neostigmine (odds ratio = 0.17; 95% CI [0.07, 0.40]).
CONCLUSIONS: Sugammadex is associated with a significantly shorter period of reversal from NMB in comparison to neostigmine in adult and pediatric patients. Regarding PONV, the use of sugammadex for NMB antagonism may offer a better option for pediatric patients.

In this review, we evaluate recent literature on use of ER granisetron in clinical practice as compared with current antiemetics and describe its potential uses for perioperative PONV prophylaxis and treatment. Recent literature was evaluated on ER granisetron use compared with currently used antiemetic agents ondansetron, droperidol, metoclopramide, promethazine, and dexamethasone with a focus on procedural anti-emesis. Though promising great effect, application of extended release granisetron to clinical use may be limited by it\'s increased relative cost.

Aim The aim of this literature review was to explore the reasons why some patients are not suitable for discharge following day surgery. Method A pragmatic, mixed-methods approach was used to undertake a critical evaluation of the literature and current practice to determine what is already known about discharge following day surgery. Thematic analysis was used to identify the main themes and issues, enabling recommendations to be made to reduce the incidence of patients unable to be discharged following day surgery. Findings The main themes or reasons for delayed discharge following day surgery identified from the literature review were: post-operative nausea and vomiting, post-operative pain, going late to theatre and social factors. These themes were supported by the findings of an unpublished audit carried out in one day surgery unit in an NHS healthcare organisation in the south of England between June and August 2014, which indicated that 54 out of 1,180 day surgery patients required an overnight stay during this 12-week period. The audit also showed that a patient going late to theatre had the greatest effect on discharge outcomes. Conclusion Recommendations for practice include: the introduction of post-operative nausea and vomiting risk scoring and prophylactic protocols; reorganisation of theatre lists to ensure patients have enough time to recover; and provision of information during the pre-assessment process about the requirement for a responsible adult escort to take patients home and stay with them for the first 24 hours. These changes may help NHS organisations to improve discharge outcomes for day surgery patients and reduce unplanned costs.