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Ondansetron dose response curve in high-risk pediatric patients
C D Lawhorn1, P J Kymer, F C Stewart
1Division of Pediatric Anesthesia, Arkansas Children's Hospital, Little Rock 72202-3591, USA.
Insights
Ondansetron effectively reduces postoperative nausea and vomiting in pediatric patients. A dose of 0.05 mg/kg is as effective as higher doses, and metoclopramide offers no additional benefit.
Area of Science:
- Anesthesiology
- Pediatric Pharmacology
Background:
- Postoperative nausea and vomiting (PONV) is a common complication in pediatric surgery.
- Effective antiemetic strategies are crucial for patient recovery and satisfaction.
Purpose of the Study:
- To determine the optimal dose of ondansetron for preventing PONV in pediatric patients.
- To investigate the additive effect of metoclopramide when combined with ondansetron.
Main Methods:
- A prospective, randomized, double-blind study was conducted with 320 pediatric patients (ages 2-12).
- Patients received varying doses of intravenous ondansetron (0.05, 0.1, 0.15 mg/kg) or placebo, with or without oral metoclopramide (0.15 mg/kg).
- Emetic episodes were monitored before and after discharge, and during the first 24 postoperative hours.
Main Results:
- All tested doses of ondansetron significantly reduced PONV incidence compared to placebo (p < 0.001).
- No significant difference in efficacy was observed between ondansetron doses of 0.05, 0.1, and 0.15 mg/kg.
- Oral metoclopramide did not alter the incidence of PONV in either ondansetron or placebo groups.
Conclusions:
- Ondansetron is a highly effective agent for preventing and treating PONV in pediatric surgical patients.
- A 0.05 mg/kg dose of ondansetron provides equivalent efficacy to higher doses.
- Metoclopramide does not enhance the antiemetic effect of ondansetron in this population.
Study Objective:
To establish a dose-response relationship for ondansetron, and to evaluate any effects of oral premedication with metoclopramide in pediatric patients undergoing tonsillectomy and adenoidectomy and strabismus surgery.
Design:
Prospective, randomized, double blind study.
Setting:
University affiliated, 280-bed pediatric hospital.
Patients:
320 ASA physical status l and II patients between the ages of 2 and 12 years undergoing tonsillectomy and adenoidectomy or strabismus surgery.
Interventions:
Patients were randomized to eight investigational groups. Patients in all eight groups underwent a standard anesthetic. Groups 1, 2, 3, and 4 received intravenous (i.v.) saline or i.v. ondansetron at doses of 0.05 mg/kg, 0.1 mg/kg and 0.15 mg/kg, respectively. Groups 5, 6, 7, and 8 received oral metoclopramide 0.15 mg/kg as well as i.v. saline, and ondansetron 0.05 mg/kg, 0.1 mg/kg, or 0.15 mg/kg. Patients were evaluated for emetic episodes prior to and following discharge.
Measurements And Main Results:
All doses of ondansetron 0.05 mg/kg, 0.1 mg/kg, and 0.15 mg/kg were significantly more effective than placebo in reducing the incidence of emesis prior to, following discharge, and during the first 24 postoperative hours (p < 0.001). There were no significant differences in the occurrence of emesis between the groups receiving ondansetron 0.05 mg/kg, 0.1 mg/kg, and 0.15 mg/kg. The addition of oral metoclopramide 0.15 mg/kg had no effect on the incidence of emesis in the ondansetron or placebo study groups.
Conclusions:
Ondansetron is an effective medication for the treatment and prevention of postoperative nausea and vomiting, and a dose of ondansetron 0.05 mg/kg is as effective as 0.1 mg/kg and 0.15 mg/kg. Metoclopramide 0.15 mg/kg has no effect on the incidence of postoperative nausea and vomiting.
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