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Single-dose ondansetron prevents postoperative vomiting in pediatric outpatients
R I Patel1, P J Davis, R J Orr
1Department of Anesthesiology, Children's National Medical Center, Washington, District of Columbia 20010, USA.
Insights
This study found that ondansetron significantly reduced postoperative vomiting in children undergoing surgery. Ondansetron also helped children meet home readiness criteria sooner, improving recovery after anesthesia.
Area of Science:
- Pediatric Anesthesiology
- Pharmacology
Background:
- Postoperative nausea and vomiting (PONV) are common in children after surgery and anesthesia.
- PONV can lead to unexpected hospital admissions following ambulatory surgery.
Purpose of the Study:
- To evaluate the safety and efficacy of ondansetron in preventing postoperative vomiting in pediatric patients.
- To compare ondansetron's effectiveness against a placebo in children aged 1-12 years.
Main Methods:
- A randomized, double-blind, parallel-group, multicenter study.
- 429 pediatric patients (ASA I-III, aged 1-12 years) received either ondansetron (0.1 mg/kg to 4 mg IV) or placebo.
- Patients underwent outpatient surgery with nitrous oxide- and halothane-based general anesthesia.
Main Results:
- Ondansetron significantly increased complete response rates for preventing vomiting at both 2-hour (89% vs. 71%) and 24-hour (68% vs. 40%) post-anesthesia discontinuation (P < 0.001).
- Ondansetron-treated patients achieved home readiness criteria 0.5 hours sooner than placebo patients (P < 0.05).
- Factors like age, intraoperative opioids, surgery type, and fluid tolerance requirements influenced emesis, but postoperative opioid use did not affect response rates.
Conclusions:
- Prophylactic administration of ondansetron is effective in reducing postoperative vomiting in pediatric patients.
- Ondansetron improves recovery outcomes, including earlier readiness for discharge, in children undergoing surgery.
Unlabelled:
This randomized, double-blind, parallel-group, multicenter study evaluated the safety and efficacy of ondansetron (0.1 mg/kg to 4 mg intravenously) compared with placebo in the prevention of postoperative vomiting in 429 ASA status I-III children 1-12 yr old undergoing outpatient surgery under nitrous oxide- and halothane-based general anesthesia. The results show that during both the 2-h and the 24-h evaluation periods after discontinuation of nitrous oxide, a significantly greater percentage of ondansetron-treated patients (2 h 89%, 24 h 68%) compared with placebo-treated patients (2 h 71%, 24 h 40%) experienced complete response (i.e., no emetic episodes, not rescued, and not withdrawn; P < 0.001 at both time points). Ondansetron-treated patients reached criteria for home readiness one-half hour sooner than placebo-treated patients (P < 0.05). The age of the child, use of intraoperative opioids, type of surgery, and requirement to tolerate fluids before discharge may also have affected the incidence of postoperative emesis during the 0- to 24-h observation period. Use of postoperative opioids did not have any effect on complete response rates in this patient population. We conclude that the prophylactic use of ondansetron reduces postoperative emesis in pediatric patients, regardless of the operant influential factors.
Implications:
Postoperative nausea and vomiting often occur after surgery and general anesthesia in children and are the major reason for unexpected hospital admission after ambulatory surgery. Our study demonstrates that the prophylactic use of a small dose of ondansetron reduces postoperative vomiting in pediatric patients.