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Oral ondansetron decreases vomiting after tonsillectomy in children
W M Splinter1, M R Baxter, H M Gould
1Department of Anaesthesia, Children's Hospital of Eastern Ontario, University of Ottawa, Canada.
Insights
Oral ondansetron significantly reduced postoperative vomiting in children undergoing tonsillectomy. This common side effect was lessened by ondansetron (OND), improving patient recovery after surgery.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Pharmacology
Background:
- Post-tonsillectomy vomiting is a frequent and distressing complication in pediatric patients.
- Intraoperative intravenous ondansetron (OND) has demonstrated efficacy in reducing post-tonsillectomy emesis.
Purpose of the Study:
- To evaluate the effectiveness of oral ondansetron (OND) in mitigating postoperative vomiting following outpatient tonsillectomy in children.
- To compare the incidence of emesis and the need for rescue antiemetics between oral OND and placebo groups.
Main Methods:
- A double-blind, placebo-controlled, randomized trial involving 233 healthy children aged 2-14 years undergoing elective tonsillectomy.
- Participants received either oral OND (0.1 mg/kg) or placebo one hour pre-surgery.
- Emesis episodes were recorded in-hospital and via parental diaries post-discharge; rescue antiemetic use was documented.
Main Results:
- Oral OND reduced the overall incidence of postoperative emesis from 54% in the placebo group to 39% (P < 0.05).
- The most significant reduction was observed in-hospital, with 10% of OND patients experiencing emesis versus 30% of placebo patients (P < 0.05).
- OND-treated children required fewer rescue antiemetics (7% vs. 17%, P < 0.05).
Conclusions:
- Oral ondansetron is effective in decreasing the incidence of vomiting after pediatric outpatient tonsillectomy.
- The use of oral OND can lead to a reduction in the need for rescue antiemetic medications.
Abstract:
Vomiting is a common, unpleasant aftermath of tonsillectomy in children. Intraoperative intravenous ondansetron (OND) reduces vomiting after this operation. Our double-blind, placebo-controlled, randomized investigation studied the effect of the oral form of OND on vomiting after outpatient tonsillectomy in children. We studied 233 healthy children age 2-14 yr undergoing elective tonsillectomy. Subjects were given placebo (PLAC) or OND 0.1 mg.kg-1 rounded off to the nearest 2 mg one hr before surgery. Anaesthesia was induced with either propofol or halothane/N2O. Vecuronium 0.1 mg.kg-1 was administered at the discretion of the anaesthetist. Anaesthesia was maintained with halothane/N2O, 50 micrograms.kg-1 midazolam iv and 1-1.5 mg.kg-1 codeine im. At the end of surgery, residual neuromuscular blockade was reversed with neostigmine and atropine. All episodes of in-hospital emesis were recorded by nursing staff. Rescue antiemetics in the hospital were 1 mg.kg-1 dimenhydrinate iv for vomiting x 2 and 50 micrograms.kg-1 droperidol iv for vomiting x 4. Parents kept a diary of emesis after discharge. Postoperative pain was treated with morphine, codeine and/or acetaminophen. The two groups were similar with respect to demographic data, induction technique and anaesthesia time. Oral OND (n = 109) reduced postoperative emesis from 54% to 39%, P < 0.05. This effect was most dramatic in-hospital, where 10% of the OND-patients and 30% of the PLAC-group vomited, P < 0.05. The OND-subjects required fewer rescue antiemetics, 7% vs 17%, P < 0.05. In conclusion, oral ondansetron decreased the incidence of vomiting after outpatient tonsillectomy in children.