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Effect of intravenous fluid therapy on postoperative vomiting in children undergoing tonsillectomy
M F Elgueta1, G C Echevarría, N De la Fuente
1División de Anestesiología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
Insights
Super-hydration with lactated Ringer's solution significantly reduced postoperative vomiting (POV) in children undergoing tonsillectomy. Increasing fluid administration to 30 ml kg(-1) h(-1) lowered POV incidence by 24% in the first 24 hours.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Pharmacology
Background:
- Postoperative vomiting (POV) is a common complication following pediatric tonsillectomy.
- Identifying effective antiemetic strategies is crucial for improving patient outcomes.
- Super-hydration is a potential method to mitigate POV.
Purpose of the Study:
- To evaluate the antiemetic efficacy of increased intraoperative fluid administration (super-hydration) using lactated Ringer's solution.
- To assess the impact of different fluid rates on the incidence of POV in pediatric patients undergoing tonsillectomy.
Main Methods:
- A randomized study of 100 children (1-12 years) undergoing elective tonsillectomy.
- Two groups received lactated Ringer's solution at 10 ml kg(-1) h(-1) or 30 ml kg(-1) h(-1) intraoperatively.
- Multivariable logistic regression analyzed the effect of fluid volume on POV incidence.
Main Results:
- The incidence of POV decreased from 82% to 62% (24% relative reduction, P=0.026) in the first 24 hours postoperatively.
- Children receiving 10 ml kg(-1) h(-1) had a 2.92-fold increased odds of POV compared to those receiving 30 ml kg(-1) h(-1).
Conclusions:
- Intraoperative administration of 30 ml kg(-1) h(-1) lactated Ringer's solution significantly reduces POV after tonsillectomy in children.
- Super-hydration is a viable strategy to decrease the risk of POV in this pediatric surgical population.
Background:
Postoperative vomiting (POV) is one of the most frequent complications of tonsillectomy in children. The aim of this study was to evaluate the antiemetic effect of super-hydration with lactated Ringer's solution in children undergoing elective otorhinolaryngological surgery.
Methods:
One hundred ASA I-II children, aged 1-12 yr, undergoing elective tonsillectomy, with or without adenoidectomy, under general anaesthesia were studied. Induction and maintenance of anaesthesia were standardized with fentanyl, mivacurium, and sevoflurane in N(2)O/O(2). Subjects were assigned to one of the two groups: 10 ml kg(-1) h(-1) lactated Ringer's solution or 30 ml kg(-1) h(-1) lactated Ringer's solution. A multivariable logistic regression was used for assessing the effects of super-hydration on POV (defined as the presence of retching, vomiting, or both). A value of P<0.05 was considered statistically significant.
Results:
During the first 24 h postoperative, the incidence of POV decreased from 82% to 62% (relative reduction of 24%, P=0.026). In the adjusted logistic regression model, subjects in the 10 ml kg(-1) h(-1) group had an odds ratio of POV that was 2.92 (95% confidence interval: 1.14, 7.51) for POV compared with subjects in the 30 ml kg(-1) h(-1) group.
Conclusions:
Intraoperative administration of 30 ml kg(-1) h(-1) lactated Ringer's solution significantly reduced the incidence of POV during the first 24 h postoperative. Our results support the use of super-hydration during tonsillectomy, as an alternative way to decrease the risk of POV in children.
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