A patient who received ondansetron and dexamethasone for PONV prophylaxis vomits twice in the recovery room two hours after surgery. According to consensus guidelines, the MOST appropriate rescue antiemetic is:

• A Repeat dose of ondansetron
• B Repeat dose of dexamethasone
• C Second dose of the same combination
• D Low-dose droperidol ✓

Explanation

Guidelines state that rescue therapy within six hours of prophylaxis should use an agent from a different pharmacological class, since repeating a 5-HT3 antagonist or steroid adds no benefit. Low-dose droperidol, a dopamine C2 antagonist, fulfils this requirement. The same logic applies to using a 5-HT3 antagonist for rescue if a butyrophenone or antihistamine was given prophylactically.

Reference: Miller's Anesthesia, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.