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Postoperative Nausea and Vomiting in Pediatric Patients
1Department of Anesthesiology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 1034, Kansas City, KS, 66160, USA. akovac@kumc.edu.
Insights
Postoperative nausea and vomiting (PONV) in children is common, but multimodal pain management and antiemetic prophylaxis can significantly reduce its occurrence and improve recovery.
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.
Abstract:
Postoperative nausea and vomiting (PONV), postoperative vomiting (POV), post-discharge nausea and vomiting (PDNV), and opioid-induced nausea and vomiting (OINV) continue to be causes of pediatric morbidity, delay in discharge, and unplanned hospital admission. Research on the pathophysiology, risk assessment, and therapy for PDNV, OINV and pain therapy options in children has received increased attention. Multimodal pain management with the use of perioperative regional and opioid-sparing analgesia has helped decrease nausea and vomiting. Two common emetogenic surgical procedures in children are adenotonsillectomy and strabismus repair. Although PONV risk factors differ between adults and children, the approach to decrease baseline risk is similar. As PONV and POV are frequent in children, antiemetic prophylaxis should be considered for those at risk. A multimodal approach for antiemetic and pain therapy involves preoperative risk evaluation and stratification, antiemetic prophylaxis, and pain management with opioid-sparing medications and regional anesthesia. Useful antiemetics include dexamethasone and serotonin 5-hydroxytryptamine-3 (5-HT3) receptor antagonists such as ondansetron. Multimodal combination prophylactic therapy using two or three antiemetics from different drug classes and propofol total intravenous anesthesia should be considered for children at high PONV risk. "Enhanced recovery after surgery" protocols include a multimodal approach with preoperative preparation, adequate intravenous fluid hydration, opioid-sparing analgesia, and prophylactic antiemetics. PONV guidelines and management algorithms help provide effective postoperative care for pediatric patients.
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