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Effects of ondansetron on emesis in the first 24 hours after craniotomy in children
S R Furst1, L J Sullivan, S G Soriano
1Department of Anesthesia, Children's Hospital, Boston, Massachusetts 02115, USA.
Insights
Ondansetron did not significantly reduce postoperative nausea and vomiting in children undergoing neurosurgery. This study found no significant difference in emesis rates between ondansetron and placebo groups within 24 hours post-operation.
Area of Science:
- Pediatric Neurosurgery
- Pharmacology
- Anesthesiology
Background:
- Children undergoing neurosurgery face a high risk of postoperative nausea and vomiting (PONV).
- Ondansetron, a 5-HT3 antagonist, is effective for PONV in other high-risk groups.
Purpose of the Study:
- To evaluate the prophylactic efficacy of intravenous ondansetron in preventing emesis in pediatric neurosurgical patients.
Main Methods:
- Prospective, randomized study comparing intravenous ondansetron (0.15 mg/kg) versus placebo.
- 60 children (aged 2-18 years) undergoing craniotomies for resective procedures were included.
- Exclusion of patients with preoperative emesis; recording of emesis episodes within 24 hours post-extubation.
Main Results:
- No significant difference in 24-hour emesis incidence: 57% (ondansetron) vs. 66% (placebo).
- Incidence in the first 8 hours was 25% (ondansetron) vs. 44% (placebo), not statistically significant.
- No difference in emesis based on tumor location (supratentorial vs. infratentorial) in the placebo group.
Conclusions:
- Ondansetron appears ineffective for preventing postoperative emesis in pediatric neurosurgical patients.
- The study's sample size was insufficient to definitively rule out a small beneficial effect.
Abstract:
Children undergoing neurosurgical resection are at high risk for postoperative nausea and vomiting. Ondansetron, a selective serotonergic (5-HT3) antagonist, is effective in reducing postoperative vomiting in several high-risk populations. In a prospective, randomized study, we compared the prophylactic use of intravenous ondansetron, 0.15 mg/kg, versus placebo for the prevention of emesis in 60 children, aged 2-18 yr, undergoing craniotomies for resective procedures. Patients with preoperative emesis were excluded from the study. All patients were tracheally extubated at the conclusion of surgery, and each episode of emesis during the first 24 postoperative hours was recorded. For the entire 24-h interval, the incidence of emesis in children who received ondansetron (57%) was not significantly different from that in those who received placebo (66%); however, in the first 8 h, the incidence was 25% (ondansetron) vs 44% (placebo) (P = not significant). In those receiving placebo, there was no difference in emesis between patients undergoing operations above versus below the tentorium. Although our sample size was too small to completely exclude any beneficial effect, ondansetron appears ineffective in preventing postoperative emesis in this patient population.