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Ondansetron and dolasetron provide equivalent postoperative vomiting control after ambulatory tonsillectomy in
Radha Sukhani1, Ana Lucia Pappas, Jordan Lurie
1Department of Anesthesiology, Loyola University Medical Center, Maywood, IL, USA. radhasukhani@yahoo.com
Insights
Ondansetron and dolasetron effectively reduced post-tonsillectomy nausea and vomiting in children when given with dexamethasone. Both drugs showed comparable efficacy, significantly outperforming placebo in preventing emesis and improving recovery.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Pharmacology
Background:
- Post-tonsillectomy nausea and vomiting (PONV) is a common complication in pediatric ambulatory surgery.
- Effective antiemetic prophylaxis is crucial for optimizing recovery and discharge after tonsillectomy.
Purpose of the Study:
- To compare the efficacy of ondansetron versus dolasetron in preventing emesis in children undergoing tonsillectomy.
- To evaluate the 48-hour recovery profiles in children receiving ondansetron, dolasetron, or placebo with dexamethasone.
Main Methods:
- Prospective, randomized, double-blinded, placebo-controlled trial involving 149 children aged 2-12 years.
- Participants received a single preoperative dose of ondansetron, dolasetron, or placebo, along with dexamethasone.
- Standardized perioperative care and rescue antiemetics were administered as needed.
Main Results:
- The incidence of retching/vomiting before discharge and at 24-48 hours post-discharge was significantly lower in the ondansetron and dolasetron groups compared to placebo.
- The need for rescue antiemetics was significantly reduced in both drug groups versus placebo.
- Complete 48-hour recovery (no emesis, no rescue antiemetic) was significantly higher in the ondansetron (76%) and dolasetron (74%) groups compared to placebo (44%).
Conclusions:
- Prophylactic ondansetron and dolasetron demonstrate comparable and significant efficacy in reducing post-tonsillectomy emesis in children pretreated with dexamethasone.
- Both antiemetics improve recovery outcomes, reducing the need for rescue medications and enhancing the likelihood of a complete 48-hour recovery.
Unlabelled:
In this prospective, randomized, double-blinded, placebo-controlled study, we compared the incidence of emesis and 48-h recovery profiles after a single dose of preoperative ondansetron versus dolasetron in dexamethasone-pretreated children undergoing ambulatory tonsillectomy. One-hundred-forty-nine children, 2-12 yr old, ASA physical status I and II, completed the study. All children received standardized perioperative care, including premedication, surgical and anesthetic techniques, IV fluids, analgesics, and rescue antiemetic medications. Patients were randomized to receive ondansetron 0.15 mg/kg, maximum 4 mg (Group 1); dolasetron 0.5 mg/kg, maximum 25 mg (Group 2); or saline placebo (Group 3) IV before the initiation of surgery. In addition, all patients received dexamethasone 1 mg/kg (maximum 25 mg). Rescue antiemetics were administered for two or more episodes of retching/vomiting. The incidence of retching/vomiting before home discharge did not differ between the ondansetron and dolasetron groups and was significantly less frequent compared with the placebo group (10%, Group 1; 8%, Group 2; 30%, Group 3). Similar results were obtained at 24-48 h after discharge (6%, Groups 1 and 2; 18%, Group 3). The need for rescue antiemetics administered after the second retching/vomiting episode was significantly less in Groups 1 (4%) and 2 (6%) compared with Group 3 (22%) before home discharge. The complete response rate, defined as no retching/vomiting and no antiemetic for 48 h, was significantly increased in Groups 1 (76%) and 2 (74%) compared with Group 3 (44%). The antiemetic efficacy of prophylactic ondansetron and dolasetron was comparable in dexamethasone-pretreated children undergoing ambulatory tonsillectomy.
Implications:
The efficacy of a single dose of prophylactic ondansetron versus dolasetron in conjunction with dexamethasone was studied on posttonsillectomy retching/vomiting and 48-h recovery in children 2-12 yr old. Compared with placebo, ondansetron and dolasetron produced comparable reductions in the incidence of retching/vomiting and the need for rescue antiemetics.