Prevention Of Postoperative Vomiting Research Articles

Is Prevention of Postoperative Vomiting Surgery Dependent? A Retrospective Cohort Study of Total Knee Arthroplasty.

The study of postoperative nausea and vomiting (PONV) has been ongoing since the early days of general anesthesia. The search for risk factors of PONV and the development of new agents to treat PONV are the two main strategies to combat the adverse side effects of general anesthesia. Female sex, non-smoking status, a history of PONV/motion sickness, and postoperative opioid use are the four independent risk factors for PONV derived after a series of prospective studies, evidence-based systematic reviews, and meta-analyses. The two frequently asked questions that arise ask whether risk factors apply to different clinical settings and whether prevention measures of PONV can be surgery dependent. We conducted a comprehensive review of 665 patients who underwent primary total knee arthroplasty (TKA) between January and December 2019. As nausea is subjective and its measurement is not standardized, postoperative vomiting (POV) was used as a study endpoint. The exclusion criteria were desflurane anesthesia, spinal anesthesia, anesthesia without bispectral index monitoring, and day surgery. Three well-recognized risk factors, consisting of body weight, sevoflurane consumption, and postoperative opioid consumption, were not considered as independent risk factors of POV, while female sex, preoperative adductor canal block (ACB), and dexamethasone were identified as being so in this study. The risk of POV in the female sex was 2.49 times that in the male sex; however, when dexamethasone was used, this risk was reduced by >40% compared with no antiemetic use, and by >50% when patients received preoperative ACB compared with those without the block. The clinical characteristics of our TKA patients—female dominance, old age, and their fairly constant body weights that were distinct from those of other surgical patients—suggested that age may play a crucial role in determining the relative contributions of the different risk factors of POV. We concluded that risk factors of POV are dependent on clinical settings. Based on these results, it is reasonable to speculate that a surgery-dependent plan for the prevention of POV is feasible for patients in similar clinical settings.

ACERTO PROJECT: IMPACT ON ASSISTANCE OF A PUBLIC EMERGENCY HOSPITAL.

ABSTRACT Background: In Brazil, the goal-based approach was named Project ACERTO and has obtained good results when applied in elective surgeries with shorter hospitalization time, earlier return to activities without increased morbidity and mortality. Aim: To analyze the impact of ACERTO on emergency surgery care. Methods: An intervention study was performed at a trauma hospital. Were compared 452 patients undergoing emergency surgery and followed up by the general surgery service from October to December 2018 (pre-ACERTO, n=243) and from March to June 2019 (post-ACERTO, n=209). Dietary reintroduction, volume of infused postoperative venous hydration, duration of use of catheters, probes and drains, postoperative analgesia, prevention of postoperative vomiting, early mobilization and physiotherapy were evaluated. Results: After the ACERTO implantation there was earlier reintroduction of the diet, the earlier optimal caloric intake, earlier venous hydration withdrawal, higher postoperative analgesia prescription, postoperative vomiting prophylaxis and higher physiotherapy and mobilization prescription were achieved early in all (p<0.01); in the multivariate analysis there was no change in the complication rates observed before and after ACERTO (10.7% vs. 7.7% (p=0.268) and there was a decrease in the length of hospitalization after ACERTO (8,5 vs. 6,1 dias (p=0.008). Conclusion: The implementation of the ACERTO project decreased the length of hospital stay, improved medical care provided without increasing the rates of complications evaluated.

Use of intravenous lidocaine in the prevention of postoperative vomiting after elective tonsillectomy in children

Use of intravenous lidocaine in the prevention of postoperative vomiting after elective tonsillectomy in children

Anti-emetic efficacy of prophylactic granisetron compared with perphenazine for the prevention of post-operative vomiting in children

Anti-emetic efficacy of prophylactic granisetron compared with perphenazine for the prevention of post-operative vomiting in children

Retracted: Prevention of postoperative vomiting with granisetron in paediatric patients with and without a history of motion sickness.

Pediatric AnesthesiaVolume 23, Issue 4 p. 378-378 RetractionFree Access Retraction This article retracts the following: Retracted: Prevention of postoperative vomiting with granisetron in paediatric patients with and without a history of motion sickness Yoshitaka Fujii MD , Yuhji Saitoh MD , Hiroyoshi Tanaka MD , Hidenori Toyooka MD , Volume 9Issue 6Pediatric Anesthesia pages: 527-530 First Published online: January 4, 2002 First published: 11 February 2013 https://doi.org/10.1111/pan.12135AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat The following article from Pediatric Anesthesia, ‘Prevention of postoperative vomiting with granisetron in paediatric patients with and without a history of motion sickness’, by Fujii Y, Saitoh Y, Tanaka H, and Toyooka H, published online in Wiley Online Library (http://onlinelibrary.wiley.com/doi/10.1046/j.1460-9592.1999.00414.x/abstract) on January 4, 2002, and in Volume 9, Number 6 (November 1999), pages 527–530 1, has been retracted by agreement between the Journal Editor, Neil Morton, and Blackwell Publishing Ltd. This article is being retracted as a result of (i) overwhelming evidence that the distributions of many variables reported by Dr Fujii in this study could not have occurred by chance 2, 3; (ii) the conclusions of an investigation conducted by the Japanese Society of Anesthesiologists 4; and (iii) the inability of Dr Fujii's institution to attest to the integrity of the study and/or its data conducted under its/their auspices 5, as set out in the Joint Editors-in-Chief Request for Determination of April 9, 2012 6. References 1Fujii Y, Saitoh Y, Tanaka H et al. Prevention of postoperative vomiting with granisetron in paediatric patients with and without a history of motion sickness. Paediatr Anaesth 1999; 9: 527– 530. Wiley Online LibraryCASPubMedWeb of Science®Google Scholar 2Carlisle JB. The analysis of 168 randomised controlled trials to test data integrity. Anaesthesia 2012; 67: 521– 537. Wiley Online LibraryCASPubMedWeb of Science®Google Scholar 3Kranke P, Apfel CC, Roewer N et al. Reported data on granisetron and postoperative nausea and vomiting by Fujii et al. Are incredibly nice! Anesth Analg 2000; 90: 1004– 1007. CrossrefCASPubMedWeb of Science®Google Scholar 4Available at http://www.anesth.or.jp/english/pdf/news20120629.pdf. Google Scholar 5 Reply to the Joint Editors-in-Chief letter. Available at http://onlinelibrary.wiley.com/store/10.1111/(ISSN)1365-2044/asset/homepages/University_of_Tsukuba_FInal_Report_on_Fujii.pdf?v=1&s=ec576f1688c45d858a16bc8d88f392a53ed7a3e5. Google Scholar 6 Joint Editors-in-Chief letter. Available at http://onlinelibrary.wiley.com/store/10.1111/(ISSN)1365-2044/asset/homepages/Fujii_Joint_EiC_letter_to_institutions_April_9.pdf?v=1&s=314f66742edb10d5399ab2e31712de1aaefc15f8. Google Scholar Volume23, Issue4April 2013Pages 378-378 ReferencesRelatedInformation

Retraction

Pediatric AnesthesiaVolume 22, Issue 12 p. 1236-1236 RetractionFree Access Retraction This article retracts the following: Retracted: The efficacy of oral clonidine premedication in the prevention of postoperative vomiting in children following strabismus surgery Fumi Handa MD, Yoshitaka Fujii MD, Volume 11Issue 1Pediatric Anesthesia pages: 71-74 First Published online: December 21, 2001 First published: 22 October 2012 https://doi.org/10.1111/pan.12065AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL The article ‘The efficacy of oral clonidine premedication in the prevention of postoperative vomiting in children following strabismus surgery’ by Handa F, Fujii Y, published in Pediatric Anesthesia 2001 Jan; 11 (1): 71–74 1 and online at http://onlinelibrary.wiley.com/doi/10.1046/j.1460-9592.2001.00615.x/abstract, is being retracted as a result of: (i) overwhelming evidence of fabrication in Dr Fujii's studies, related to the fact that the distributions of many variables reported in these studies could not have occurred by chance 2, 3; and (ii) the inability of Dr Fujii's institution (Hyogo Prefectural Kobe Children's Hospital) to attest to the integrity of the study and/or its data, or ethical approval, conducted under its auspices, as set out in the Joint Editors-in-Chief Request for Determination of April 9, 2012 4. References 1Handa F, Fujii Y. The efficacy of oral clonidine premedication in the prevention of postoperative vomiting in children following strabismus surgery. Pediatr Anaesth 2001; 11: 71– 74. 2Carlisle JB. The analysis of 168 randomised controlled trials to test data integrity. Anaesthesia 2012; 67: 521– 537. 3Kranke P, Apfel CC, Roewer N et al. Reported data on granisetron and postoperative nausea and vomiting by Fujii et al. Are incredibly nice! Anesth Analg 2000; 90: 1004– 1007. 4 Joint Editors-in-Chief letter. Available at: http://onlinelibrary.wiley.com/store/10.1111/(ISSN)1365-2044/asset/homepages/Fujii_Joint_EiC_letter_to_institutions_April_9.pdf?v=1&s=314f66742edb10d5399ab2e31712de1aaefc15f8. Volume22, Issue12December 2012Pages 1236-1236 ReferencesRelatedInformation

Comparing the preventive effect of midazolam and midazolam-dexamethasone on postoperative nausea and vomiting in elective middle ear surgery

Background:Nausea and vomiting are common postoperative complications with incidence of 20–80% depends on the surgery type, anesthetic drugs, age, sex, etc. This complication may lead to patient discomfort, intraocular, and intracerebral pressures increase, sutures rupture, esophageal injury, and rarely death. Many studies reported that midazolam and dexamethasone alone can decrease postoperative nausea and vomiting (PONV), but their combination has never been studied yet. The aim of this study was to compare the effect of midazolam and midazolam-dexamethasone on PONV after middle ear surgery.Materials and Methods:66 ASA I and II patients aged 15–65 year scheduled for elective middle ear surgery under general anesthesia randomly divided into two groups. Immediately after induction of the anesthesia group one (M) received midazolam 0.075 mg/kg and group two (M+D) received combination of midazolam (0.075 mg/kg) plus dexamethasone (0.05 mg/kg). Then the severity of nausea was measured by visual analog scales 0–10 (VAS) in recovery room at 6, 12, and 24 h after surgery. Metoclopramid (0.1 mg/kg) was administrated I.V. slowly if nausea score was above 3 or patient had vomiting. The postoperative need for antiemetics and the duration of stay in recovery room were recorded. Values of P<0.05 were considered statistically significant.Results:There were no significant differences in age, gender, and weight between the two groups. There was no significant difference in the mean nausea scores between two groups except after 12 h postoperatively (1.39 ± 3.19 in M group vs. 0.42 ± 1.71 in M+D group). The mean vomiting frequency was significantly less in midazolam-dexamethasone group in the recovery room (0.9 ± 0.29 vs. 0 ± 0) and at 6–12 h (1.09 ± 2.41 vs. 0.3 ± 0.8), and 12–24 h (0.42 ± 1.32 vs. 0.03 ± 0.17) postoperatively. During the first 24 h postoperatively, the metoclopramid consumption was significantly less in combination therapy (6.48 ± 9.54) than in the midazolam group (12.9 ± 23.44) (Value<0.5).Conclusion:The combination of midazolam-dexametazone is more effective than midazolam alone in prevention of postoperative vomiting after middle ear surgery. Therefore, we recommend combination therapy for patients who are prone to PONV.

Genetic polymorphisms in the serotonin receptor type 3B gene (HTR3B) and the clinical response to ondansetron in Koreans

We performed a pharmacogenetic study to analyse the correlation between the clinical responses to ondansetron during a 24-h postoperative period and two single nucleotide polymorphisms (−100_–102 delAAG and ins/delCA) in the serotonin receptor type 3B gene (HTR3B) in 280 Korean patients with tonsillectomy (TS, n=108) or surgery because of gynaecological problems (GY, n=172). The effect of CA/CA homogyzous variant of the ins/delCA allele on lowering the prevention of postoperative vomiting was significant, particularly during the initial 2 h postoperative period (P=0.034) and in the GY group (P=0.013 for complete response and P=0.009 for prevention of vomiting). However, we failed to detect a significant effect of genotypes for the −100_–102delAAG allele during our observation period. Our results suggest that ins/delCA polymorphism in the HTR3B may have clinical relevance to the expected clinical response to prevent postoperative vomiting in patients treated with ondansetron.

The Effect of Ondansetron and Dexamethasone for the Prevention of Postoperative Vomiting Following Endoscopic Retrograde Cholangiopancreatography in Children

Purpose: Postoperative vomiting (POV) is a frequent pediatric problem occurring at highly variable rates following different surgical procedures. Endoscopic retrograde cholangiopancreatography (ERCP) is performed with increasing frequency in children and has become largely a therapeutic procedure. POV is felt to result from both patient and procedure related factors. Although not a surgical procedure, pediatric ERCP utilizes general anesthesia and involves extensive pharyngeal manipulation; thus, POV may occur. This study was undertaken to determine the frequency of POV following ERCP in children and to evaluate two commonly used regimens of POV prophylaxis. Methods: This is a retrospective review of 66 children who underwent ERCP on 68 occasions between 2005 and 2009. Demographic data was recorded, and patients were divided into two groups for the purpose of analysis. The choice of prophylaxis was at the discretion of the anesthesiologists based on their assessment of risk. Group A consisted of 31 patients (17 female, mean age 9.65 years, range 3 months-14 years) who received prophylaxis for POV with ondansetron alone. Group B was composed of 37 patients (21 female, mean age 9.72 years, range 4-14 years) who received prophylaxis with a combination of ondansetron and dexamethasone. Univariate and multivariate analysis was performed to compare the two methods of prophylaxis and to identify the demographic traits, endoscopic findings, and therapeutic interventions associated with POV. Results: POV occurred in 22/68 (32.4%) of children, including 14/31 (45.1%) of Group A and 8/37 (21.6%) of Group B. POV occurred with similar frequency in males and females. On univariate analysis a history of motion sickness (p=0.002) and increasing age (p=0.02) were associated with POV. Therapeutic interventions found to be risk factors for POV include common bile duct (CBD) sphincterotomy (p=0.005), CBD stone extraction (p=0.001), and combined endoscopic sphincterotomy with balloon sphincteroplasty (EST/BS) (p=0.005). Wire guided cannulation (p=0.003), as well as the duration of ERCP (p=0.01), were associated with POV. On multivariate analysis prophylaxis with dexamethasone combined with ondansetron was more effective than odansetron alone in the prevention of POV (OR=0.155, 95% CI=0.033-0.722). Conclusion: 1. POV occurred in 32.3% of children following ERCP, a finding similar to many surgical procedures. 2. Prophylaxis with ondansetron combined with dexamethasone was more effective in preventing POV than ondansetron alone. 3. Motion sickness, increasing age, and duration of ERCP are POV risk factors. 4. Therapeutic interventions identified as risk factors for POV included CBD sphincterotomy, EST/BS, CBD stone extraction, and wire guided technique.

Superior anti‐emetic efficacy of granisetron–dexamethasone combination in children undergoing middle ear surgery

To compare the effectiveness of granisetron and a granisetron-dexamethasone combination for the prevention of post-operative vomiting in children undergoing middle ear surgery. Ninety ASA physical status I or II children, aged 3-12 years, were randomly assigned to three groups of 30 each to receive a single dose of placebo (normal saline), granisetron 40 microg/kg or a combination of granisetron 40 microg/kg and dexamethasone 150 microg/kg intravenously after the induction of anaesthesia. Peri-operative anaesthetic care was standardized in all children. Post-operatively, during the first 24 h after anaesthesia, the frequencies of retching and vomiting and the incidence of adverse events were recorded. Rescue anti-emetic was administered if two or more episodes of emesis occurred. Post-operative pain was treated with morphine intravenously, followed by acetaminophen orally. There were no differences between the treatment groups with regard to demographic data. A complete response (no retching/vomiting and no need for rescue anti-emetic) was achieved in 50%, 80% and 96.67% of children who received saline, granisetron and granisetron-dexamethasone, respectively (P < 0.05). Six children who received placebo and one who received granisetron alone required another rescue anti-emetic. The incidence of adverse events was comparable in the three groups. The prophylactic granisetron-dexamethasone combination was more effective than granisetron alone in the prevention of post-operative emesis during the first 24 h after anaesthesia in children undergoing middle ear surgery.

Anaesthesia for paediatric ENT surgery

Children requiring anaesthesia for surgery on the ear, nose or throat (ENT) account for a large proportion of the paediatric anaesthetic workload in the district general or teaching hospital. Most of these children are otherwise healthy, but there are also patients with syndromes and genetic disorders that need regular ENT input (e.g. Treacher Collins, Down's or the mucopolysaccharidoses). Anaesthesia for these children represents a significant challenge and the anaesthetist should be aware of all the implications of the disease. This article concentrates on commonly performed ENT procedures and reviews anaesthetic techniques and strategies for prevention of postoperative vomiting (POV). Adenotonsillectomy is often performed to relieve recurrent tonsillitis or the symptoms of obstructive sleep apnoea (OSA). The main anaesthetic concerns are: analgesia, POV, and risk of postoperative haemorrhage. Patients with OSA are particularly sensitive to opiates and sedative agents, and may require postoperative observation on a high-dependency or ICU. The laryngeal mask airway is used by some anaesthetists for airway management and have the advantages of decreased lower airway soiling by blood but may make surgical access more difficult. The ‘bleeding tonsil’ is a surgical emergency. The main anaesthetic implications are: a potentially hypovolaemic child, a full stomach of swallowed blood, repeat anaesthesia, a potentially difficult airway. Anaesthesia for this should be undertaken by the most senior anaesthetist available. Day-case tonsillectomy has been performed for a number of years in North America and Canada. It is now increasingly considered in the UK primarily for socio-economic reasons. This needs to be done safely with carefully considered patient selection, parental information and an anaesthetic and surgical technique to minimize postoperative side effects. Middle ear and auditory canal procedures are reviewed briefly.

Ondansetron is highly effective for the prevention of postoperative vomiting in infants,

Ondansetron is highly effective for the prevention of postoperative vomiting in infants,

A Double-Blind Comparison of Intravenous Ondansetron and Placebo for Preventing Postoperative Emesis in 1- to 24-Month-Old Pediatric Patients After Surgery Under General Anesthesia

We assessed the efficacy and safety of ondansetron (0.1 mg/kg IV) prophylactically administered before surgery for prevention of postoperative vomiting (POV) in a double-blind, placebo-controlled study of 670 pediatric patients, 1- to 24-mo-old, undergoing elective surgery under general anesthesia. The study enrolled 335 children in each treatment group (ondansetron versus placebo). Significantly fewer children treated with ondansetron exhibited emesis or discontinued the study prematurely after surgery (ondansetron, 11%; placebo, 28%; odds ratio = 0.33; P < 0.0001). The number required to treat prophylactically with ondansetron to prevent POV was approximately six. Ondansetron treatment also resulted in fewer patients requiring rescue medication or assumed to have had rescue upon early discontinuation from the study during the postoperative period (ondansetron, 5%; placebo, 10%) and less emesis (0 of 6) after rescue medication when compared with placebo (7 of 21). The incidence of POV and other antiemetic effects of ondansetron were similar in children aged 1-12 mo and 13-24 mo and in children prospectively expected or not expected to require opioids as part of their anesthetic or analgesic management. Ondansetron was well tolerated; the incidence of adverse events considered possibly related to study drug was similar between treatment groups (ondansetron, 1.8%; placebo, 1.5%). This prospective, randomized, double-blind, placebo-controlled study establishes the efficacy and tolerability of IV ondansetron (0.1 mg/kg) in the prevention of postoperative emesis in 1- to 24-mo-old pediatric patients undergoing elective surgery under general anesthesia.

Transcutaneous Electrical Acupoint Stimulation Versus Ondansetron in the Prevention of Postoperative Vomiting Following Pediatric Tonsillectomy

Postoperative retching and vomiting is an important cause of morbidity that may lead to patient discomfort, distress, and complications. Stimulation of acupuncture points has been shown to be effective in the prevention as well as treatment of PONV. The current treatments of choice are the 5-hydroxytryptamine type 3-antagonists, such as ondansetron. We aimed to evaluate the efficacy and side-effects of either transcutaneous electrical acupoint stimulation (TEAS) or Ondansetron compared to a control group receiving no treatment in the prevention of postoperative retching and vomiting. SUBJECT AND DESIGN: This randomized, controlled, prospective study was carried out in a group of 90 children (in three equal randomly assigned groups), aged between 4 and 12 who underwent tonsillectomy under general anesthesia. In the first group, electrical stimulation via surface electrodes on acupoints Neiguan and Shangwan was performed (20 Hz, 5 minutes). The second group received a single dose of Ondansetron (0.15 mg . kg(-1)). No treatment was given to the control group. The frequency of retching and vomiting attacks and side-effects were noted on the day of surgery in the postanesthesia care unit and the day surgery care unit, on the day of surgery after discharge, and on the first day after surgery. A satisfaction scale was completed by each family. There was a significant difference between the treatment groups and the control group in the incidence of emetic episodes occurring in the day surgery care unit and on the day after discharge (p < 0.001). In the ondansetron group, side-effects were seen in more patients than in the other groups (p < 0.001). The satisfaction scores of the parents were greater in the treatment groups than in the control group (p < 0.05). Application of TEAS on sedated children is an easy, painless, reliable and effective method for the prophylaxis of postoperative retching and vomiting in pediatric tonsillectomy.

The efficacy and safety of transdermal scopolamine for the prevention of postoperative nausea and vomiting: a quantitative systematic review.

The role of scopolamine administered via transdermal therapeutic systems in the prevention of postoperative vomiting, nausea, and nausea and vomiting is unclear. We performed a systematic search for full reports of randomized comparisons of transdermal scopolamine with inactive control. Dichotomous data were extracted. In the meta-analysis, relative risks and numbers-needed-to-treat/harm were calculated with 95% confidence intervals (CI). In 23 trials, 979 patients received transdermal scopolamine, and 984 patients received placebo. Sensitivity analyses were performed using restricted data for truncated control event rates (40%-80%) and for large trials. With these data, the relative risks for postoperative vomiting (five reports), nausea (five reports), nausea and vomiting (eight reports), and rescue treatment (three reports) were 0.69 (95% CI, 0.58-0.82), 0.69 (95% CI, 0.54-0.87), 0.76 (95% CI, 0.66-0.88), and 0.68 (95% CI, 0.54-0.85), respectively. This means that of 100 patients who receive transdermal scopolamine, approximately 17 will not experience postoperative vomiting who would have done so had they all received a placebo. However, 18 of 100 patients will have visual disturbances, eight will report dry mouth, two will report dizziness, one will be classified as being agitated, and 1-13 patients who are prescribed transdermal scopolamine will not use it correctly. The timing of application does not alter efficacy. Of 100 patients who receive transdermal scopolamine, approximately 17 will not vomit in the postoperative period who would have done so had they all received a placebo. However, 18 of 100 patients will have visual disturbances, and eight will report dry mouth. Incorrect use further limits its efficacy.

Prophylactic ondansetron for postoperative emesis. Meta-analysis of its effectiveness in patients with previous history of postoperative nausea and vomiting.

The objective of this study was to compare, by means of meta-analysis, the postoperative antiemetic efficacy of ondansetron in patients with and without antecedents of postoperative nausea and vomiting. MEDLINE and EMBASE databases were searched for randomised placebo-controlled trials which evaluated the antiemetic effectiveness of 4 mg and 8 mg intravenous doses of prophylactic ondansetron in adult patients. A further selection was with respect to those studies which noted the patient's previous history of postoperative nausea and vomiting (PH-PONV) and, for the meta-analysis, the patients were divided into two sub-groups: those with (PH-PONV +) and those without a previous history of postoperative nausea and vomiting (PH-PONV -). Absence of vomiting was used as the index of effectiveness. Twenty-one trials involving 3984 patients (2446 in ondansetron groups and 1538 in placebo groups; 1163 PH-PONV(+) patients and 2821 PH-PONV(-) patients) met the selection criteria. The effectiveness of the 4 mg dose of ondansetron was: OR (95% CI)=2.40 (1.77-3.26) vs. 2.71 (2.23-3.30) for the patients of PH-PONV(+) and PH-PONV(-) sub-groups, respectively. For the 8 mg dose, the effectiveness of ondansetron was: PH-PONV(+)=4.21 (2.66-6.66) and PH-PONV(-)=2.61 (1.81-3.59). For neither of the doses evaluated was there any significant statistical difference between the sub-groups. The effectiveness of ondansetron in the prevention of postoperative vomiting is not affected by the patients' PH-PONV.

Anti-emetic efficacy of prophylactic granisetron compared with perphenazine for the prevention of post-operative vomiting in children

Anti-emetic efficacy of prophylactic granisetron compared with perphenazine for the prevention of post-operative vomiting in children

Dimenhydrinate Decreases Vomiting After Strabismus Surgery in Children

Dimenhydrinate, an H1-receptor antagonist, has been used to both prevent and treat postoperative vomiting (POV) in children for several decades. However, its effectiveness for POV after strabismus surgery remains anecdotal. This study was designed to determine the effectiveness and side effects of dimenhydrinate for the prevention of POV in children after strabismus surgery. Eighty ASA physical status I or II children, ages 1-12 yr inclusive, who were undergoing strabismus surgery, were prospectively and randomly allocated to receive either dimenhydrinate 0.5 mg/kg intravenously (n = 40) or placebo (n = 40) at induction of anesthesia. The incidence of POV and the times to arousal (and discharge from the recovery room and hospital) were recorded postoperatively in a double blinded manner. For 24 h after discharge from the hospital, all emetic episodes and medications given were recorded by the parents. Demographic data did not differ between the groups. Children who received dimenhydrinate had significantly less POV both inhospital (10%) and overall (30%) than those who received placebo (in-hospital 38%, P < 0.008; overall 65%, P < 0.003). The times to arousal and discharge from the hospital did not differ between the two groups. Dimenhydrinate (0.5 mg/kg) is an effective, safe, and inexpensive antiemetic in children undergoing strabismus surgery. It significantly reduces the incidence of vomiting for 24 h postoperatively and is not associated with prolonged sedation or other adverse effects.

Effectiveness of Droperidol and Ondansetron for the Prevention of Postoperative Vomiting in Pediatric Patients

Effectiveness of Droperidol and Ondansetron for the Prevention of Postoperative Vomiting in Pediatric Patients

TRIMETHOBENZAMIDE for Prevention of Postoperative Emesis in Pediatric Patients

TRIMETHOBENZAMIDE for Prevention of Postoperative Emesis in Pediatric Patients