Ondansetron reduces nausea and vomiting after paediatric adenotonsillectomy

Abstract

SummaryThe efficacy, safety and resource implications of a single intravenous dose of ondansetron (0.1 mg·kg −1 , maximum 4 mg) were assessed in a multinational, multicentre, randomized, double-blind, placebocontrolled trial of 427 children aged 1-12 years, undergoing tonsillectomy with/without adenoidectomy. Emesis (retching and/or vomiting) and nausea were analysed separately. Significantly more ondansetron-treated children had no episodes of emesis (127/212 (60%) vs 100/215 (47%); P=0.004) and experienced no postoperative nausea (135/211 (64%) vs 108/213 (51%); P=0.004) in the first 24 h. Ondansetron also reduced the number of emetic episodes (P<0.001), the time to the first emetic episode (P<0.001) and overall nausea severity (P=0.003). Significantly fewer ondansetron-treated children were rescued or withdrawn from the study (5% vs 10%; P=0.042). Fewer ondansetron-treated patients required nursing intervention (34% vs 45%; P=0.007) and the average intervention time was significantly shorter (4.6 vs 8.1 minutes; P=0.001). Resources used to manage PONV were significantly reduced by ondansetron (43% vs 57%; P=0.014).

Prevention of postoperative nausea and vomiting in children following adenotonsillectomy, using tropisetron with or without low-dose dexamethasone

“…Nevertheless, in spite of prophylaxis with intravenous tropisetron, the incidence of postoperative vomiting is unacceptably high, ranging from 29% to 55% with a trend to higher values when opioids are used perioperatively (Table 3) [1,[3][4][5]. Similar results have been reported for other 5-HT 3 antagonists [6][7][8][9][10].…”

Postoperative symptoms at home following day‐case surgery in children: a multicentre survey of 551 children

“…However, as the occurrence of PONV in hospital was the most significant factor to predict PONVat home, we recommend that all children who have emetic symptoms in hospital should be given effective, longacting anti-emetic medication, with minimal side-effects, such as a 5HT 3 receptor antagonist [24,25]. Prophylactic administration of ondansentron has been effective in high-risk children and it has reduced the resources needed to manage PONV [26]. Contrary to some other investigations, in which one dose of morphine or papaveretum significantly increased the incidence of PONV [5][6][7], fentanyl or alfentanil given during anaesthesia did not do so in our patients.…”

Propofoleinsatz für Hals-Nasen-Ohren-Eingriffe im Kindesalter

“…In der Metaanalyse von Tramèr et al [38] findet sich für die Tonsillektomie beim Kind unter Anwendung von Halothan und Lachgas zur Narkose eine POV-Inzidenz von 50. Die Untersuchungen in der Multizenterstudie von Morton et al [24] zeigen, dass nach Adenotonsillektomie beim Einsatz von Lachgas und volatilen Anästhetika 53 der untersuchten 2-12 Jahre alten Kinder postoperativ erbrechen.…”

“…Die Rolle volatiler Anästhetika als Risikofaktor für POV/PONV ist durch viele Studien belegt worden [1,17,24]. Dagegen konnten zahlreiche Untersuchungen eine signifikante PONV-Minderung nach Propofolanwendung zeigen [14,28,34].…”

“…Der Einsatz von Propofol zur Narkoseerhaltung bei typischen HNO-Eingriffen im Kleinkind-und Vorschulalter, die mit einer erhöhten Inzidenz an POV/PONV einhergehen (s. oben; [17,21,24,28,38] [33,37].…”