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Management of postoperative vomiting in pediatric patients

Mehernoor F Watcha1

  • 1Department of Anesthesiology & Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA. watcha@email.chop.edu

Current Opinion in Anaesthesiology
|October 6, 2006
PubMed

Insights

Postoperative vomiting is common after anesthesia, especially in children. This review guides anesthesiologists in choosing prophylactic antiemetics based on patient risk and cost-effectiveness.

Area of Science:

  • Anesthesiology
  • Pharmacology

Background:

  • Postoperative vomiting (POV) is a frequent complication of general anesthesia, disproportionately affecting children.
  • Current prophylactic antiemetics offer limited efficacy and potential side effects.
  • Newer 5-HT3 antagonists are effective but costly; older agents like droperidol face safety concerns.

Purpose of the Study:

  • To review literature to assist anesthesiologists in selecting patients who would benefit from prophylactic antiemetics.
  • To discuss factors influencing POV and Consensus Panel recommendations for risk reduction.
  • To address the controversy surrounding droperidol's 'black box warning' and guide rescue therapy choices.

Main Methods:

  • Literature review examining factors influencing postoperative vomiting.
  • Analysis of Consensus Panel recommendations for managing POV.
  • Discussion of drug efficacy, safety profiles, and cost-effectiveness.

Main Results:

  • Factors influencing POV are both controllable and uncontrollable by anesthesiologists.
  • Evidence supports individualized approaches to prophylactic antiemetic use in selected cases.
  • Alternative drug classes are recommended for rescue therapy when initial prophylaxis fails.

Conclusions:

  • Anesthesiologists should employ evidence-based medicine for managing POV.
  • An individualized approach balancing drug choice, patient risk, and cost is crucial for effective management.
Abstract

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