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Ondansetron is a better prophylactic antiemetic than droperidol for tonsillectomy in children
W M Splinter1, E J Rhine, D W Roberts
1Department of Anaesthesia, Children's Hospital of Eastern Ontario, University of Ottawa, Canada.
Insights
Ondansetron (OND) is more effective than droperidol (DROP) in preventing vomiting after pediatric tonsillectomy. This study found OND reduced both in-hospital and overall emesis incidence, requiring fewer rescue antiemetics.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Pharmacology
Background:
- Post-tonsillectomy nausea and vomiting (PONV) is common in children.
- Both intravenous ondansetron (OND) and droperidol (DROP) are used to manage PONV.
Purpose of the Study:
- To compare the efficacy of OND and DROP as prophylactic antiemetics in pediatric patients undergoing tonsillectomy.
Main Methods:
- A randomized, double-blind study involving 276 healthy children aged 2-12 years.
- Subjects received either OND (150 mcg/kg) or DROP (50 mcg/kg) intravenously after anesthesia induction.
- Emesis was recorded for 24 hours post-surgery, with rescue antiemetics administered for severe cases.
Main Results:
- The incidence of in-hospital emesis was significantly lower in the OND group (16%) compared to the DROP group (30%).
- Fewer rescue antiemetics were needed for OND-treated patients (5% vs. 13%).
- Overall emesis incidence was 45% for OND versus 57% for DROP.
Conclusions:
- Ondansetron demonstrated superior prophylactic antiemetic activity compared to droperidol for pediatric tonsillectomy.
- OND is a more effective option for reducing vomiting in children after this surgical procedure.
Abstract:
Both intravenous ondansetron (OND) and droperidol (DROP) have been observed to reduce vomiting after tonsillectomy in children. This randomized, double-blind investigation compared the effect of OND and DROP on vomiting after outpatient tonsillectomy in 276 healthy children age 2-12 yr. All subjects received a standardized anaesthetic, which consisted of induction with either propofol or halothane/N2O, vecuronium 0.1 mg x kg(-1) on an as needed basis, maintenance with halothane/N2O, midazolam and codeine, and reversal of neuromuscular blockade with neostigmine and atropine on an as needed basis. Subjects were given either OND 150 micrograms x kg(-1) or DROP 50 micrograms x kg(-1)iv after induction of anaesthesia. Rescue antiemetics in the hospital were administered to patients who vomited X 2 and X 4, respectively. Postoperative pain was treated with morphine, codeine and/or acetaminophen. For 24 hr following surgery, emesis was recorded by nursing staff while subjects were in the hospital, and by parents following discharge from hospital. The two groups were similar with respect to demographic data, induction technique and anaesthesia time. The frequency of in-hospital emesis was 16% in the OND-patients and 30% in the DROP-group, P <0.05. The OND-subjects required fewer rescue antiemetics, 5% vs 13%, P <0.05. The overall incidence of emesis was 45% in the OND-group and 57% in the DROP-group, P <0.05. In conclusion, ondansetron was a superior prophylactic antiemetic for tonsillectomy in children when compared to droperidol.