Current review of ramosetron in the prevention of postoperative nausea and vomiting.

Postoperative nausea and vomiting (PONV) are distressing and frequent adverse events of anesthesia and surgery. Serotonin receptor antagonists (SRAs), including ondansetron, granisetron, tropisetron, dolasetron, and ramosetron, effectively decrease the incidence of PONV. Among these SRAs, ramosetron is the most effective antiemetic for the prophylaxis against PONV in terms of the inhibitory potency, binding rate, and stabilizing its pharmacological activity. This review article focused on the efficacy of ramosetron for preventing PONV in adults and postoperative vomiting (POV) in children. Because of young age of pediatric patients, nausea was not assessed a separate entity. MEDLINE (PubMED) and EMBASE (January 1990 - September 2010) were searched for randomized, double-blind, (placebo-controlled), studies (written in English) of ramosetron for preventing PONV in adults and POV in children. The incidence of PONV during 0-24 h after anesthesia was less in patients receiving ramosetron 0.3 mg than in those receiving placebo, in adults undergoing gynecologic surgery, dilatation and curettage, laparoscopic cholecystectomy, middle ear surgery, thyroidectomy, and total hip/knee replacement. The incidence of POV during 0-24 h after anesthesia was less in pediatric patients receiving ramosetron 6 mcg kg(-1) than in those receiving placebo, in children undergoing strabismus surgery and tonsillectomy. In adults, the most commonly reported adverse effect was headache (5-20%). In children, clinically serious adverse events, such as excessive sedation and extrapyramidal symptoms, were not observed. Prophylactic therapy with ramosetron is effective for preventing PONV in adults and POV in children without clinically serious adverse effects.