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Kaviani, N., & Ranjbaran, F. (2011). Evaluation of the efficacy of oral ondansetron on gag reflex in soft palate and palatine tonsil areas. Journal of Isfahan Dental School, 6(6), 691–697.

Here’s an interesting study I stumbled across at http://emcrit.org/blogpost/ondanestron-for-awake-intubation/. The original is in (I believe) Arabic, but the abstract is interesting enough in itself. It’s a study done by Dentists in the Middle East using placebo vs. ondansetron to test if ondansetron administration resulted in a decreased gag reflex; apparently it does. This would make it a useful adjunct to intubation in an awake patient. The original article is available here: http://jids.mui.ac.ir/index.php/jids/article/viewFile/240/1349

More information about IV ondansetron is available from this (always excellent) New Zealand government site: http://www.medsafe.govt.nz/profs/Datasheet/o/ondansetronclarisinj.pdf

Abstract

Introduction

Severe gagging in some patients during dental procedures can complicate the procedure. In this study, the effect of oral ondansetron and placebo, as antiemetic medications, on gag reflex was evaluated with the stimulation of soft palate and palatine tonsil areas to simulate the clinical situation during dental procedures.

Materials and methods

In this clinical trial, 88 healthy adult individuals were randomly divided into two equal groups of ondansetron and placebo, which were administered orally. Gag reflexes were checked using a tongue depressor and recorded before and 90 minutes after intervention in the soft palate and palatine tonsil areas. Data was analyzed and compared with SPSS software, using Mann-Whitney and Wilcoxon tests (α = 0.05).

Results

In the ondansetron group a statistically significant decrease in gag reflex was noted after intervention in both soft palate and tonsil areas (p value < 0.05); however, no significant decrease was observed in the placebo group in the two areas after intervention.

Conclusion

The results of the present study showed the efficacy of ondansetron in reducing the severity of gag reflex in both the soft palate and tonsil areas; therefore, its administration can be considered in clinical procedures in those areas.

Bottom line, it may be useful to administer ondansetron IV before attempting awake intubation in order to reduce the gag reflex.