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Prophylactic antiemetic treatment with ondansetron in children undergoing tonsillectomy
1Department of Anesthesia and Critical Care, Childrens Hospital and Health Center, San Diego, California.
Insights
Ondansetron significantly reduced postoperative vomiting in children after tonsillectomy, while metoclopramide and droperidol were ineffective. This finding highlights ondansetron as a key treatment for preventing post-tonsillectomy nausea and emesis.
Area of Science:
- Pediatric Anesthesiology
- Pharmacology
- Surgical Outcomes
Background:
- Postoperative vomiting is a common complication in children undergoing tonsillectomy.
- Effective antiemetic strategies are crucial for pediatric surgical care.
Purpose of the Study:
- To compare the efficacy of ondansetron, metoclopramide, and droperidol in preventing postoperative vomiting after pediatric tonsillectomy.
- To evaluate the effectiveness of ondansetron versus placebo in this patient population.
Main Methods:
- A prospective, double-blind, randomized study involving 256 pediatric patients (ages 2-12) undergoing tonsillectomy.
- Patients received intravenous placebo, ondansetron (0.15 mg/kg), metoclopramide (0.5 mg/kg), or droperidol (0.075 mg/kg) after anesthesia induction.
- Outcomes were assessed through recovery room observation and 24-hour telephone follow-up.
Main Results:
- Ondansetron reduced the incidence of postoperative emesis from 62% to 27% (relative risk 0.45, P < 0.001).
- Metoclopramide and droperidol showed no significant effect on preventing postoperative vomiting compared to placebo.
Conclusions:
- Intravenous ondansetron (0.15 mg/kg) is highly effective in preventing postoperative emesis in children undergoing tonsillectomy.
- Metoclopramide and droperidol, at the tested doses, are ineffective for this indication.
Background:
Children undergoing tonsillectomy are at high risk for postoperative vomiting. This study was undertaken to compare ondansetron with metoclopramide and droperidol for the prevention of postoperative vomiting after tonsillectomy.
Methods:
Two hundred fifty-six pediatric patients, ages 2-12 years, scheduled for outpatient tonsillectomy were enrolled in a prospectively randomized, double-blinded investigation and assigned to one of four treatment regimens: placebo (saline), ondansetron 0.15 mg.kg-1, metoclopramide 0.5 mg.kg-1, or droperidol 0.075 mg.kg-1. Study drugs were administered intravenously after inhalation induction of anesthesia with halothane, nitrous oxide, and oxygen. No premedication or neuromuscular blocking agents were used. Tracheal extubation was performed while patients were still deeply anesthetized. Acetaminophen and meperidine were given for postoperative pain. Patients were observed in the recovery room for a minimum of 4 h before discharge. Parents were contacted by telephone 24 h later for follow-up.
Results:
Ondansetron reduced the incidence of postoperative emesis from 62% to 27% (relative risk 0.45, 95% confidence interval 0.29 to 0.70, P < 0.001). Metoclopramide and droperidol had no significant effect on postoperative vomiting.
Conclusions:
The intravenous administration of ondansetron 0.15 mg.kg-1 is highly effective in reducing postoperative emesis in children undergoing tonsillectomy. Metoclopramide and droperidol at the doses tested are ineffective in this population.