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Ondansetron decreases postoperative vomiting in pediatric patients undergoing tonsillectomy and adenoidectomy
C D Lawhorn1, C Bower, R E Brown
1Department of Anesthesiology, Arkansas Children's Hospital, Little Rock 72202, USA.
Insights
Ondansetron and droperidol effectively reduce postoperative vomiting after tonsillectomy and adenoidectomy in children. Ondansetron offers superior, longer-lasting antiemetic effects without sedation, making it ideal for pediatric surgical care.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Pharmacology
Background:
- Tonsillectomy and adenoidectomy are common pediatric procedures.
- Postoperative nausea and vomiting (PONV) frequently lead to hospital readmission.
- Current antiemetics like metoclopramide and droperidol show limited efficacy in preventing PONV.
Purpose of the Study:
- To compare the efficacy of ondansetron, droperidol, and placebo in preventing PONV.
- To evaluate the antiemetic effects of ondansetron, a novel serotonin antagonist.
- To reduce unplanned hospitalizations due to PONV in pediatric patients.
Main Methods:
- Prospective, randomized, double-blinded clinical trial.
- 165 children (2-12 years) undergoing ambulatory adenotonsillectomy.
- Administration of ondansetron, droperidol, or placebo at general anesthesia induction.
Main Results:
- Both ondansetron and droperidol significantly reduced postoperative emesis compared to placebo (P < 0.012).
- Ondansetron demonstrated superior efficacy over droperidol in reducing emesis post-discharge (P < 0.025).
- Ondansetron provided sustained antiemetic effects for 24 hours without significant side effects.
Conclusions:
- Ondansetron and droperidol are effective in preventing PONV in pediatric tonsillectomy and adenoidectomy patients.
- Ondansetron is more effective than droperidol for sustained PONV control.
- Ondansetron should be considered for standard management of PONV in this pediatric population.
Abstract:
One of the most frequently performed pediatric surgical procedures is tonsillectomy and adenoidectomy. Nausea and vomiting and the inability to tolerate oral fluids lead to unplanned hospitalizations. Despite treatment with metoclopramide and droperidol, nausea and vomiting continue to be high after this procedure. We designed this investigation to compare currently utilized antiemetics to ondansetron, a new serotonin antagonist, in hopes of decreasing the occurrence of nausea and vomiting in patients undergoing tonsillectomy and adenoidectomy. This prospective, randomized, double-blinded clinical trial compared ondansetron, droperidol, and placebo administered at the induction of general anesthesia and the incidence of vomiting postoperatively. One-hundred sixty-five children between the ages of 2 and 12 years undergoing ambulatory adenotonsillectomy were enrolled and completed this investigation. The primary outcome measure was the elimination of vomiting during the 24-h investigative period following surgery. Both ondansetron and droperidol significantly lowered the incidence of postoperative emesis after tonsillectomy and adenoidectomy (P < 0.012) compared to placebo. Ondansetron was significantly more effective than droperidol in reducing emesis after discharge (P < 0.025). Both ondansetron and droperidol are effective in decreasing emesis when given before surgical incision in pediatric patients undergoing tonsillectomy and adenoidectomy. Ondansetron's antiemetic effect persists for up to 24 h following surgery with significant reductions in emesis. Ondansetron's effectiveness in eliminating vomiting without sedation or other side effects suggests that it should be considered as part of the standard management in pediatric patients undergoing tonsillectomy and adenoidectomy.