• Jaime B Hyman, Chang Park, Hung-Mo Lin, Beatriz Cole, Leigh Rosen, Suzanne S Fenske, Rachel L Barr Grzesh, Stephanie V Blank, Sylvie B Polsky, Matthew Hartnett, Peter J Taub, Vijay Palvia, Samuel DeMaria, and Charles Ascher-Walsh.
• From the Department of Anesthesiology, Perioperative and Pain Medicine (J.B.H., C.P., B.C., M.H., S.D.) Department of Population Health Science and Policy (H.-M.L.) Division of Gynecology, Department of Obstetrics, Gynecology and Reproductive Science (L.R., R.L.B.G., V.P., C.A.-W.) Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Blavatnik Family Women's Health Research Institute (S.V.B.) Division of Plastic and Reconstructive Surgery, Department of Surgery (P.J.T.), Icahn School of Medicine at Mount Sinai, New York, New York Suzanne Fenske, M.D., P.C., Brookville, New York (S.S.F.) Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts (S.B.P.).
• Anesthesiology. 2020 Jun 1; 132 (6): 1419-1428.

BackgroundPostdischarge nausea and vomiting after ambulatory surgery is a common problem that is not adequately addressed in current practice. This prospective, randomized, double-blind, parallel-group, placebo-controlled study was designed to test the hypothesis that oral olanzapine is superior to placebo at preventing postdischarge nausea and vomiting.MethodsIn a single-center, double-blind, randomized, placebo-controlled trial, the authors compared a single preoperative dose of olanzapine 10 mg to placebo, in adult female patients 50 years old or less, undergoing ambulatory gynecologic or plastic surgery with general anesthesia. All patients received standard antiemetic prophylaxis with dexamethasone and ondansetron. The primary composite outcome was nausea and/or vomiting in the 24 h after discharge. Secondary outcomes included severe nausea, vomiting, and side effects.ResultsA total of 140 patients were randomized and evaluable. The primary outcome occurred in 26 of 69 patients (38%) in the placebo group and in 10 of 71 patients (14%) in the olanzapine group (relative risk, 0.37; 95% CI, 0.20 to 0.72; P = 0.003). Severe nausea occurred in 14 patients (20%) in the placebo group and 4 patients (6%) in the olanzapine group (relative risk, 0.28; 95% CI, 0.10 to 0.80). Vomiting occurred in eight patients (12%) in the placebo group and two patients (3%) in the olanzapine group (relative risk, 0.24; 95% CI, 0.05 to 1.10). The median score for sedation (scale 0 to 10, with 10 being highest) in the 24 h after discharge was 4 (interquartile range, 2 to 7) in the placebo group and 6 (interquartile range, 3 to 8) in the olanzapine group (P = 0.023).ConclusionsWhen combined with ondansetron and dexamethasone, the addition of olanzapine relative to placebo decreased the risk of nausea and/or vomiting in the 24 hafter discharge from ambulatory surgery by about 60% with a slight increase in reported sedation.

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