Postoperative Nausea and Vomiting in Pediatric Patients

Area of Science:

• Pediatric Anesthesiology
• Surgical Patient Care
• Pharmacology

Background:

• Postoperative nausea and vomiting (PONV), including post-discharge (PDNV) and opioid-induced (OINV) forms, are significant causes of pediatric morbidity, delayed discharge, and hospital readmissions.
• Adenotonsillectomy and strabismus repair are common pediatric surgeries associated with high emetogenic potential.
• While risk factors for PONV differ between adults and children, strategies to mitigate risk share similarities.

Purpose of the Study:

• To review current research on the pathophysiology, risk assessment, and therapeutic strategies for PONV in pediatric patients.
• To highlight the benefits of multimodal approaches in managing PONV and pain.
• To provide guidance on antiemetic prophylaxis and pain management for pediatric surgical patients.

Main Methods:

• Review of literature on PONV, PDNV, and OINV in pediatric populations.
• Analysis of multimodal pain management strategies, including regional anesthesia and opioid-sparing analgesia.
• Evaluation of antiemetic prophylaxis regimens, including dexamethasone and 5-HT3 receptor antagonists like ondansetron.
• Discussion of enhanced recovery after surgery (ERAS) protocols in the context of PONV prevention.

Main Results:

• Multimodal pain management, combining regional and opioid-sparing analgesia, effectively reduces nausea and vomiting.
• Preoperative risk evaluation, antiemetic prophylaxis, and opioid-sparing pain management are key components of a multimodal approach.
• Combination prophylactic therapy with multiple antiemetics and propofol TIVA is recommended for high-risk children.
• ERAS protocols integrate these multimodal strategies for improved postoperative outcomes.

Conclusions:

• A multimodal strategy encompassing preoperative risk assessment, targeted antiemetic prophylaxis, and opioid-sparing analgesia is crucial for effective PONV management in children.
• Guidelines and algorithms for PONV management aid in optimizing postoperative care for pediatric surgical patients.
• Continued research and adherence to evidence-based protocols can minimize PONV-related complications in children.