Effects of Anticholinergics on Postoperative Vomiting, Recovery, and Hospital Stay in Children Undergoing Tonsillectomy with or without Adenoidectomy

Chhibber, Ashwani K.; Lustik, Stewart J.; Thakur, Rajbala; Francisco, David R.; Fickling, Kenneth

doi:10.1097/00000542-199903000-00010

Cited by 43 publications

(29 citation statements)

References 13 publications

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“…After the children in both groups had vomited the swallowed blood, they were ready to be discharged. If the child is premedicated to prevent postoperative nausea and vomiting, the prevention may mask possible postoperative bleeding [26,5,27,1], and blood loss may not become evident to the parents until the child vomits at home [26]. Some children may vomit swallowed blood after discharge because the bleeding may continue unrecognized for an extended period of time [26], and parents do not necessarily contact the health care personnel despite the child's bleeding after tonsillectomy [44].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, nausea is a common problem after pediatric tonsillectomy and, according to the literature, more than half of the children vomit [2][3][4]. Posttonsillectomy bleeding is also one of the risks and swallowed blood may be a reason for postoperative nausea and vomiting [5,6].…”

Section: Introductionmentioning

confidence: 99%

“…Other non-pharmacological methods, such as different ventilation techniques and electroacupuncture, have also been studied but no greater significance effect has been found [24,25]. The child's nausea and vomiting is probably multifactorial [2,4] and swallowed blood may be one of the probable reasons for a child's vomiting after tonsillectomy [26,5,27,1].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The effect of preoperative fasting on postoperative pain, nausea and vomiting in pediatric ambulatory tonsillectomy

Klemetti

Kinnunen

Suominen

et al. 2009

International Journal of Pediatric Otorhinolaryngology

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The effect of preoperative fasting on postoperative pain, nausea and vomiting in pediatric ambulatory tonsillectomy

Klemetti

Kinnunen

Suominen

et al. 2009

International Journal of Pediatric Otorhinolaryngology

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“…Die Antagonisierung von nichtdepolarisierenden Muskelrelaxanzien ist ebenfalls emetogen, wobei dies nach einer Metaanalyse vor allem für Dosierungen von mehr als 2,5 mg Neostigmin gelten soll [64].Da in Studien bei höheren Dosierungen überwiegend Glycopyrrolat und bei niedrigeren Dosierungen überwiegend Atropin zur Verwendung kam,ist eine definitive Aussage schwierig,da Atropin im Gegensatz zu Glycopyrrolat zentrale antiemetische Wirkungen besitzt und mit weniger Erbrechen assoziiert ist [17].…”

Section: Anästhesiologische Risikofaktorenunclassified

Postoperative �belkeit und Erbrechen

Roewer

2004

Anaesthesist

108

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Numerous pathophysiological mechanisms are known to cause nausea or vomiting but their role for postoperative nausea and vomiting (PONV) is not quite clear. Volatile anesthetics, nitrous oxide and opioids appear to be the most important causes for PONV. Female gender, non-smoking and a history of motion sickness and PONV are the most important patient specific risk factors. With these risk factors an objective risks assessment is achievable as a good rational basis for a risk dependent antiemetic approach: When the risk is low, moderate, or high, the use of none, a single or a combination of prophylactic antiemetic interventions seems to be justified. Performing a total intravenous anesthesia (Ti.v.A) with propofol is a reasonable prophylactic approach, but does not solve the problem satisfactorily alone if the risk is very high, reducing the risk of PONV only by 30%. This is comparable to the reduction rate of antiemetics, such as serotonin antagonist, dexamethasone and droperidol. It must be stressed that metoclopramide is ineffective. Data from IMPACT indicate that prophylaxis is not very effective if the patients risk is low. At a moderate risk the use of Ti.v.A or an antiemetic is reasonable and only a (very) high risk justifies the combination of several prophylactic antiemetic interventions. For the treatment of PONV an antiemetic should be chosen which has not been used prophylactically. The necessary doses are usually a quarter of those needed for prophylaxis.

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“…Evidence from randomized, controlled trials after 1998 [14][15][16][17][18] Since March 1998, four more studies have investigated the contribution of pharmacological reversal of residual paralysis to PONV. Data from 503 patients on different doses of neostigmine combined with different doses of atropine or glycopyrrolate in adults and children were analysed (Table 1).…”

Section: Theoretical Considerationsmentioning

confidence: 99%

Use of reversal agents in day care procedures (with special reference to postoperative nausea and vomiting)

Fuchs‐Buder

Mencke

2001

Eur J Anaesthesiol

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There is some confusion about the contribution of reversal of residual paralysis to the occurrence of postoperative nausea and vomiting. The aim of this review is to discuss whether antagonism of residual paralysis is a cause of postoperative nausea and vomiting, and to assess the risk of residual paralysis if the reversal is omitted. Data from a meta-analysis published before 1998 were considered, along with trials published after that date to assess the influence of reversal of residual paralysis on postoperative nausea and vomiting, and the likelihood of harm when antagonism was omitted. Moreover, an overview of pathophysiological consequences, incidence and clinical consequences of residual paralysis is given and the actual criteria of the adequacy of neuromuscular recovery presented.When emetic outcomes are combined across all trials and all different neostigmine doses, there is no beneficial effect from omitting neostigmine on postoperative nausea and vomiting, but there is some evidence of a dose-responsiveness with neostigmine; higher doses may have emetic properties. However, omitting reversal introduces a non-negligent risk of residual paralysis. An improved understanding of the pathological consequences of residual paralysis (i.e. impaired laryngeal and pharyngeal muscle function, alterations in hypoxic ventilatory control, reduced margin of safety) led to establishment of more rigorous criteria for defining adequacy of neuromuscular recovery. A train-of-four ratio of !0.9 is now accepted as the index of adequate recovery of neuromuscular function. Applying this new definition, residual paralysis becomes a frequent adverse side-effect. Neuromuscular recovery should therefore be routinely monitored in ambulatory patients and residual paralysis prevented by reversing neuromuscular block.

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Effects of Anticholinergics on Postoperative Vomiting, Recovery, and Hospital Stay in Children Undergoing Tonsillectomy with or without Adenoidectomy

Abstract: In children undergoing tonsillectomy with or without adenoidectomy, reversal of neuromuscular blockade with atropine and neostigmine is associated with a lesser incidence of postoperative emesis compared with glycopyrrolate and neostigmine.

Cited by 43 publications

References 13 publications

The effect of preoperative fasting on postoperative pain, nausea and vomiting in pediatric ambulatory tonsillectomy

The effect of preoperative fasting on postoperative pain, nausea and vomiting in pediatric ambulatory tonsillectomy

Postoperative �belkeit und Erbrechen

Use of reversal agents in day care procedures (with special reference to postoperative nausea and vomiting)

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