title: Oral ondansetron decreases vomiting after tonsillectomy in children.
abstract: Vomiting is a common, unpleasant aftermath of tonsillectomy in children. Intraoperative intravenous ondansetron (OND) reduces vomiting after this operation. Our double-blind, placebo-controlled, randomized investigation studied the effect of the oral form of OND on vomiting after outpatient tonsillectomy in children. We studied 233 healthy children age 2-14 yr undergoing elective tonsillectomy. Subjects were given placebo (PLAC) or OND 0.1 mg.kg-1 rounded off to the nearest 2 mg one hr before surgery. Anaesthesia was induced with either propofol or halothane/N2O. Vecuronium 0.1 mg.kg-1 was administered at the discretion of the anaesthetist. Anaesthesia was maintained with halothane/N2O, 50 micrograms.kg-1 midazolam iv and 1-1.5 mg.kg-1 codeine im. At the end of surgery, residual neuromuscular blockade was reversed with neostigmine and atropine. All episodes of in-hospital emesis were recorded by nursing staff. Rescue antiemetics in the hospital were 1 mg.kg-1 dimenhydrinate iv for vomiting x 2 and 50 micrograms.kg-1 droperidol iv for vomiting x 4. Parents kept a diary of emesis after discharge. Postoperative pain was treated with morphine, codeine and/or acetaminophen. The two groups were similar with respect to demographic data, induction technique and anaesthesia time. Oral OND (n = 109) reduced postoperative emesis from 54% to 39%, P < 0.05. This effect was most dramatic in-hospital, where 10% of the OND-patients and 30% of the PLAC-group vomited, P < 0.05. The OND-subjects required fewer rescue antiemetics, 7% vs 17%, P < 0.05. In conclusion, oral ondansetron decreased the incidence of vomiting after outpatient tonsillectomy in children.
authors.affiliation: Department of Anaesthesia, Children's Hospital of Eastern Ontario, University of Ottawa, Canada.
authors.forename: W M
authors.initials: WM
authors.lastname: Splinter
authors.forename: M R
authors.initials: MR
authors.lastname: Baxter
authors.forename: H M
authors.initials: HM
authors.lastname: Gould
authors.forename: L E
authors.initials: LE
authors.lastname: Hall
authors.forename: H B
authors.initials: HB
authors.lastname: MacNeill
authors.forename: D J
authors.initials: DJ
authors.lastname: Roberts
authors.forename: L
authors.initials: L
authors.lastname: Komocar
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000556:Ambulatory Surgical Procedures; D000762:Anesthesia Recovery Period; D000769:Anesthesia, Inhalation; D000771:Anesthesia, Intravenous; D002648:Child; D002675:Child, Preschool; D004111:Dimenhydrinate / Q000008:administration & dosage / Q000627:therapeutic use; D004311:Double-Blind Method; D004329:Droperidol / Q000008:administration & dosage / Q000627:therapeutic use; D017558:Elective Surgical Procedures; D006801:Humans; D017294:Ondansetron / Q000008:administration & dosage / Q000627:therapeutic use*; D010149:Postoperative Pain / Q000188:drug therapy; D010351:Patient Discharge; D010919:Placebos; D011292:Premedication; D014068:Tonsillectomy / Q000009:adverse effects*; D014839:Vomiting / Q000517:prevention & control*
chemical_list: D010919:Placebos; D017294:Ondansetron; D004111:Dimenhydrinate; D004329:Droperidol