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Subhypnotic propofol does not treat postoperative vomiting in children after adenotonsillectomy
M M Zestos1, A S Carr, G McAuliffe
1Department of Anaesthesia, Hospital for Sick Children, University of Toronto, Ontario, Canada.
Insights
A subhypnotic dose of propofol did not effectively treat vomiting in children after adenotonsillectomy. This treatment also caused increased pain and sedation compared to placebo.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Pharmacology
Background:
- Postoperative nausea and vomiting (PONV) is a common complication in children following adenotonsillectomy.
- Effective antiemetic strategies are crucial for improving pediatric postoperative recovery.
Purpose of the Study:
- To evaluate the efficacy of a subhypnotic dose of propofol in managing PONV in pediatric patients undergoing adenotonsillectomy.
- To compare the antiemetic effect of propofol with a placebo in this patient population.
Main Methods:
- A prospective, double-blinded, placebo-controlled study involved 70 children (aged 2-12 years) experiencing PONV after adenotonsillectomy.
- Participants received either intravenous propofol (0.2 mg/kg) or intralipid (10%) placebo.
- Outcomes measured included vomiting recurrence and adverse events like pain and sedation.
Main Results:
- The overall incidence of vomiting was 50%.
- Propofol did not significantly reduce vomiting recurrence compared to placebo (63% vs. 57%, P=NS).
- Propofol administration led to significantly higher rates of injection pain (54% vs. 3%) and mild sedation (46% vs. 11%) compared to placebo (P < 0.003).
Conclusions:
- A subhypnotic intravenous dose of propofol is ineffective for treating PONV in children after adenotonsillectomy when using a specific standardized anesthetic protocol.
- Propofol, at this dose, is associated with increased incidence of pain on injection and mild sedation.
- Alternative antiemetic strategies should be considered for managing PONV in this pediatric surgical context.
Purpose:
To investigate the efficacy of a subhypnotic dose of propofol to treat vomiting in children after adenotonsillectomy.
Methods:
Two hundred and fifty-two children, aged 2-12 yr, underwent a standardized anaesthetic opioid administration, and postoperative care after adenotonsillectomy, adenoidectomy or tonsillectomy. A prospective, double-blinded, placebo-controlled study was performed in 70 of the patients who retched or vomited after surgery and who had intravenous access. Patients were assigned randomly to receive either 0.2 mg.kg-1) propofol (n = 35), or placebo (intralipid 10%, n = 35).
Results:
The overall incidence of vomiting during the first 18-24 hr was 50%. Of those who had received propofol after the first episode of vomiting, 63% relapsed requiring a rescue antiemetic compared with 57% of those who had received intralipid (P = NS). Of the children who received propofol, 54% experienced pain on injection and 46% were mildly sedated compared with 3% and 11%, respectively, in the placebo group (P < 0.003).
Conclusion:
We conclude that an intravenous bolus of 0.2 mg.kg-1 propofolis not effective in the treatment of postoperative vomiting in children after adenotonsillectomy when a standardized anaesthetic with thiopentone, halothane, nitrous oxide, and 1.5 mg.kg-1 codeine phosphate is used, but it does cause sedation and pain on injection.