Use of Ondansetron for Control of Projectile Vomiting in Patients with Neurosurgical Trauma: Two Case Reports

Abstract

OBJECTIVE: To describe two cases of projectile vomiting that were treated successfully with ondansetron in patients with neurosurgical trauma. Causes and pharmacologic treatments for nausea and emesis are also discussed. DATA SOURCES: Patient data and literature citations from published case reports, review articles, and clinical research reports as identified by MEDLINE. DATA SYNTHESIS: Ondansetron, a potent and highly selective antagonist of serotonin at the 5-HT3 (subtype 3)-receptor, possesses potent antiemetic effects. It has not been associated with 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 agents interfere with serial mental status examinations and lower the seizure threshold. Therefore, ondansetron may be preferable in this patient population. Two patients with head trauma and projectile vomiting were treated successfully with ondansetron following treatment failure with prochlorperazine. These represent the first reported cases of efficacious treatment with ondansetron in neurosurgical trauma patients. CONCLUSIONS: Ondansetron may be the preferred agent for controlling nausea and vomiting in patients with neurosurgical trauma. Controlled clinical trials are needed to evaluate its safety and efficacy in this patient population.