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Postoperative emesis following otoplasty in children
D Paxton1, R H Taylor, T M Gallagher
1Department of Anaesthesia, Royal Belfast Hospital for Sick Children, Northern Ireland.
Insights
Ondansetron significantly reduced vomiting and allowed earlier oral intake in children undergoing otoplasty compared to droperidol or placebo. This antiemetic offers a better post-operative recovery for pediatric surgical patients.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Pharmacology
Background:
- Postoperative nausea and vomiting (PONV) are common complications in pediatric surgery.
- Effective antiemetic strategies are crucial for improving patient recovery and comfort.
- Otoplasty is a common pediatric surgical procedure where PONV can impact recovery.
Purpose of the Study:
- To compare the efficacy of ondansetron, droperidol, and placebo in preventing PONV in children undergoing otoplasty.
- To evaluate the impact of these agents on the time to oral fluid and food ingestion post-surgery.
Main Methods:
- A randomized controlled trial involving 60 unpremedicated children aged 3-14 years scheduled for otoplasty.
- Patients were assigned to receive ondansetron (0.1 mg/kg), droperidol (75 mcg/kg), or placebo at anesthesia induction.
- Standard general anesthesia with thiopental, atracurium, and halothane was administered, avoiding intraoperative opioids.
Main Results:
- Ondansetron significantly reduced vomiting incidence (15%) compared to droperidol (40%) and placebo (60%) (p < 0.01).
- Children receiving ondansetron tolerated oral fluids and solids earlier (p < 0.001).
- No significant difference in vomiting or oral intake time was observed between droperidol and placebo groups.
Conclusions:
- Ondansetron is an effective antiemetic for pediatric otoplasty, improving recovery by reducing nausea and vomiting.
- Ondansetron facilitates earlier resumption of oral feeding compared to droperidol or placebo.
- While a transient nodal rhythm was noted with ondansetron, it was not clinically significant, and no other adverse events were reported.
Abstract:
Sixty unpremedicated children aged between 3 and 14 years, scheduled for otoplasty, were randomly divided into one of three groups to receive either ondansetron 0.1 mg.kg-1, droperidol 75 micrograms.kg-1, or placebo at induction of anaesthesia. All patients received a standard general anaesthetic using thiopentone, atracurium and halothane. Opioid analgesia was avoided intra-operatively and infiltration with local anaesthetic was used prior to the start of surgery. Children who received ondansetron were less likely to vomit (15%) than those who received either droperidol (40%) or placebo (60%) (p < 0.01). This group also tolerated oral ingestion of fluids and solids earlier than those who received either droperidol or placebo (p < 0.001). There was no difference between the placebo or droperidol group in the incidence of vomiting or time to ingestion of oral fluids and meals. Three patients in the ondansetron group had a self-terminating nodal rhythm which was not associated with any haemodynamic disturbances. Postoperatively there were no untoward incidents in any of the groups and all patients were discharged home the day after surgery.