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Prophylaxis for vomiting by children after tonsillectomy: ondansetron compared with perphenazine
1Department of Anaesthesia, Children's Hospital of Eastern Ontario, Ottawa, Canada.
Insights
Ondansetron and perphenazine showed similar effectiveness in preventing vomiting after pediatric tonsillectomy. Male sex was identified as a significant predictor of postoperative vomiting in children.
Area of Science:
- Pediatric Anesthesiology
- Pharmacology
- Surgical Outcomes
Background:
- Postoperative nausea and vomiting (PONV) are common complications following pediatric tonsillectomy.
- Effective antiemetic strategies are crucial for optimizing recovery and discharge in day-case surgery.
Purpose of the Study:
- To compare the efficacy of ondansetron and perphenazine in preventing vomiting after tonsillectomy in children.
- To identify predictors of postoperative vomiting and its impact on hospital stay.
Main Methods:
- A randomized, double-blind, stratified, blocked study involving 216 healthy children (aged 2-12 years).
- Anesthesia induced with propofol or halothane/nitrous oxide.
- Intravenous administration of ondansetron (150 µg/kg) or perphenazine (70 µg/kg) post-induction.
- Standardized perioperative management and discharge criteria.
Main Results:
- Ondansetron and perphenazine demonstrated comparable efficacy in controlling postoperative vomiting (44% vs 41%, P = 0.77).
- Male sex was the sole significant predictor of vomiting, with a higher incidence in males (49% vs 35%, P = 0.016).
- Each episode of in-hospital vomiting prolonged day-care unit stay by an average of 7 minutes (P = 0.015).
Conclusions:
- Ondansetron and perphenazine offer similar effectiveness for managing PONV in pediatric tonsillectomy patients.
- Male gender is a key risk factor for PONV post-tonsillectomy.
- Minimizing vomiting can contribute to shorter hospital stays in day-case pediatric surgery.
Abstract:
We have compared the effects of ondansetron and perphenazine on vomiting after tonsillectomy in 216 healthy children, aged 2-12 yr. The study was randomized, stratified, blocked and double blind. Anaesthesia was induced with propofol i.v. or by inhalation of halothane and nitrous oxide. Ondansetron 150 micrograms kg-1 or perphenazine 70 micrograms kg-1 was administered i.v. after induction of anaesthesia in a double-blind manner. Perioperative management of emesis, pain, fluids and patients discharge were standardized. Ondansetron and perphenazine had similar effects on postoperative vomiting (44% vs 41%; ondansetron vs perphenazine P = 0.77). By logistic regression analysis, the only significant predictor of postoperative vomiting was sex, that is males had a greater incidence of vomiting (49% vs 35%; P = 0.016). In-hospital vomiting was associated with a prolongation of stay in the day-care surgical unit of 7 min per episode of vomiting (P = 0.015). We conclude that ondansetron and perphenazine had similar effects on vomiting in children after tonsillectomy in a day-case setting.