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Concealed post-tonsillectomy haemorrhage associated with the use of the antiemetic tropisetron

P G Herreen1, M C Wiese

  • 1Department of Paediatric Anaesthesia, Adelaide Women's and Children's Hospital, South Australia.

Anaesthesia and Intensive Care
|August 22, 2001
PubMed

Insights

Postoperative nausea and vomiting (PONV) is common after adenotonsillectomy. Antiemetic treatment, like tropisetron, may mask concealed hemorrhage, emphasizing careful patient observation post-surgery.

Area of Science:

  • Pediatric Surgery
  • Anesthesiology
  • Gastroenterology

Background:

  • Adenotonsillectomy is frequently associated with postoperative nausea and vomiting (PONV).
  • Prophylactic antiemetic medication is often administered to mitigate PONV in pediatric patients.
  • Concealed hemorrhage is a potential, albeit rare, postoperative complication.

Observation:

  • A two-year-old child developed concealed hemorrhage following adenotonsillectomy.
  • The patient presented with melaena stools but without significant hematemesis or gastric blood.
  • Prophylactic antiemetic treatment with tropisetron was administered prior to surgery.

Findings:

  • The absence of significant vomiting or gastric blood may have been influenced by the antiemetic medication.
  • Melaena stools indicated gastrointestinal bleeding, suggesting a concealed hemorrhage.
  • This case highlights the potential for antiemetics to mask overt signs of bleeding.

Implications:

  • Antiemetic treatment is valuable in managing PONV in this patient group.
  • Careful and prolonged postoperative observation is crucial, irrespective of antiemetic use.
  • Clinicians should maintain a high index of suspicion for complications like hemorrhage even when symptoms appear controlled.

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