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.
The purpose of this study was to assess the effect of midazolam on vomiting after tonsillectomy in children. We compared 215 children aged 1.5-14 yr undergoing tonsillectomy or adenotonsillectomy under general anaesthesia with nitrous oxide and halothane. In a double-blind fashion the subjects were administered either placebo or midazolam 75 micrograms.kg-1 iv after induction of anaesthesia. After the operation, the number of emetic episodes and the length of stay in hospital were recorded. The groups were similar with respect to age, weight, sex, mode of induction, duration of anaesthesia, surgical procedure, opioid administration and length of stay in the PAR and the Day Care Surgical Unit. The 108 midazolam-treated children had a lower incidence (42% vs 57%) of vomiting than the placebo group, P < 0.02. The placebo group had a higher incidence (9% vs 2%) of unscheduled admissions to hospital due to nausea and vomiting, P < 0.05. It is concluded that midazolam administered intravenously to children intraoperatively reduces vomiting after tonsillectomy.
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