From a very smart doctor friend: “That’s a rough article. This person definitely falls outside the usual mechanisms of nausea. I’m always interested in this st

From a very smart doctor friend: “That’s a rough article. This person definitely falls outside the usual mechanisms of nausea. I’m always interested in this stuff because managing post operative nausea and vomiting is a huge part of anesthesia. I made a protocol for our ambulatory surgery center using a newer dopamine base drug Amisulpride. Works great for most people. The best one is Aprepitant which is an NK1 inhibitor, pretty cool mechanism, works great for chemo nausea and is super effective for anesthesia related nausea BUT is very expensive. I wonder if anyone offered this patient Droperidol. It’s a cousin of Haloperidol minus the anti-psychotic and sedating effects. It was pulled off the market due to a black box warning that it could cause QT prolongation and a potentially fatal heart arrhythmia but turns out that data was bad and for nausea doses it prolongs the QT interval no longer than many other drugs we allow on the market. I’d say #1 drug for anti nausea is Aprepitant (Emend), #2 success is Amisulpride, #3 Zofran, #4 scopolamine patch. Each has a totally different mechanism. Funny enough I had a patient today who failed all those except Emend (we don’t have it on formulary cuz of cost). You know what worked? 25mg of IV Benadryl. The guy was STILL there at 3pm after being first knee replacement case at 7AM, still puking. Tried everything, even 50mg IV Dextrose. Nope. But IV Benadryl got him out the door in 20 minutes. Totally weird. Reglan is a really shitty drug, like of all the dopamine mechanism drugs it has the worst side effects. I never give it. Once you’ve seen one patient get the Akathisia from it (they will writhe and want to jump out of their skin) you won’t give it again.”