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Effective dose of granisetron for preventing postoperative emesis in children
1Department of Anaesthesiology and Critical Care Medicine, Tokyo Medical and Dental University School of Medicine, Japan.
Insights
Granisetron effectively prevents postoperative vomiting in children undergoing common surgeries. A dose of 40 micrograms.kg-1 is sufficient, with higher doses offering no additional benefit for preventing pediatric postoperative emesis.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Pharmacology
Background:
- Postoperative nausea and vomiting (PONV) are common complications in pediatric surgery.
- Selective 5-hydroxytryptamine type 3 receptor antagonists are used to manage PONV.
Purpose of the Study:
- To determine the minimum effective dose of granisetron for preventing postoperative vomiting in children.
- To evaluate granisetron's efficacy in pediatric patients undergoing strabismus repair, tonsillectomy, or tonsillectomy with adenoidectomy.
Main Methods:
- A randomized, double-blind study involving 80 children (4-10 years old).
- Participants received placebo, or granisetron at 20, 40, or 80 micrograms.kg-1 intravenously post-anesthesia induction.
- Standardized anesthesia (sevoflurane, nitrous oxide, oxygen) and rescue antiemetic protocols were used.
Main Results:
- No significant differences in patient characteristics, surgical, or anesthetic management were observed between groups.
- Vomiting frequencies were 65% (placebo), 60% (20 µg/kg), 20% (40 µg/kg), and 15% (80 µg/kg).
- Granisetron at 40 and 80 µg/kg significantly reduced the need for rescue antiemetics compared to placebo and the 20 µg/kg dose.
Conclusions:
- Granisetron at 40 micrograms.kg-1 is an effective dose for preventing postoperative emesis in pediatric patients.
- Increasing the granisetron dose to 80 micrograms.kg-1 did not provide additional antiemetic benefits.
Purpose:
This study was to identify the minimum effective dose of granisetron, a selective 5-hydroxytryptamine type 3 receptor antagonist, to prevent postoperative vomiting in children who have undergone strabismus repair, tonsillectomy or tonsillectomy with adenoidectomy.
Methods:
In a randomized, double-blind fashion, 80 healthy children aged 4-10 yr were assigned to receive either placebo (saline) or granisetron in a dose of 20, 40 or 80 micrograms.kg-1 iv immediately following the induction of anaesthesia. All subjects received a standardized anaesthetic, which consisted of sevoflurane in nitrous oxide and oxygen. Rescue antiemetics were administered if two or more episodes of vomiting occurred. Postoperative pain was treated with acetaminophene pr or pentazocine iv. During the first 24 hr after anaesthesia, the frequencies of retching and vomiting were recorded in a standardized fashion by nursing staff while subjects were in a hospital.
Results:
There were no differences among four treatment groups with regard to subject characteristics, surgical procedures, anaesthetic and postoperative management or adverse effects. The frequencies of these symptoms were as follows: 65%, 60%, 20% and 15% after administration of placebo, granisetron 20, 40 or 80 micrograms.kg-1. Three children who had received either placebo or granisetron 20 micrograms.kg-1 required another rescue antiemetic drug, whereas none who had received granisetron 40 or 80 micrograms.kg-1 needed rescue drugs.
Conclusion:
Granisetron 40 micrograms.kg-1 is an effective antiemetic for preventing retching and vomiting following strabismus repair and tonsillectomy in children. Increasing the dose to 80 micrograms.kg-1 provided no demonstrable benefit in reducing postoperative emesis.