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Postoperative vomiting in children. A persisting unsolved problem
Insights
Postoperative nausea and vomiting (PONV) in children is a significant concern. This study found PONV occurred in 19.5% of pediatric surgical patients, influenced by anesthesia type, surgery, and pain management.
Area of Science:
- Pediatric Anesthesiology
- Surgical Patient Outcomes
- Postoperative Care
Background:
- Postoperative nausea and vomiting (PONV) is a common and distressing complication in pediatric patients following anesthesia and surgery.
- Identifying risk factors is crucial for developing effective prevention and management strategies.
Purpose of the Study:
- To prospectively investigate the incidence of PONV in a pediatric surgical population.
- To analyze the relationship between PONV and anesthetic technique, surgical procedure, and postoperative analgesia.
Main Methods:
- A prospective survey of 2370 pediatric surgical patients over one year (September 1989-September 1990).
- Data collection included patient demographics, anesthesia and surgical details, and postoperative follow-up via telephone for outpatients.
- Analysis focused on the overall incidence and specific risk factors for vomiting.
Main Results:
- The overall incidence of vomiting was 19.5%, lower than previously reported.
- Increased vomiting risk was observed in children over 2 years, after specific operative procedures, and following general anesthesia.
- Postoperative opioid administration was associated with a higher risk of vomiting.
Conclusions:
- While the overall PONV incidence was relatively low, certain surgical procedures and anesthetic approaches led to a high frequency.
- Strategies such as regional anesthesia, prophylactic antiemetic medication, and novel anesthetics may reduce PONV in pediatric patients.
Abstract:
Nausea and vomiting after anaesthesia and surgery in children remains a major problem. The following survey studies the frequency of postoperative vomiting and relates it to the anaesthetic technique, the surgical procedure, and postoperative analgesia. During one year, September 1989 until September 1990, 2370 surgical patients requiring anaesthesia were studied prospectively with the following protocol: 1) patient data, surgery and anaesthesia technique; and 2) postoperative follow-up were registered. Outpatients were followed up by telephone. The overall incidence of vomiting was 19.5%, which was lower than in other studies. An increased incidence of vomiting was found in children over 2 years of age, after certain operative procedures, and after general anaesthesia. Furthermore, postoperative opioid administration on the ward increased the risk of vomiting. Despite the low overall incidence of vomiting in our study, we still found a high frequency after certain surgical procedures. The use of regional anaesthesia, prophylactic antiemetic medication, and the introduction of new anaesthetics, may help to reduce the sometimes high incidence of postoperative nausea and vomiting in paediatric patients.