title: Preoperative ketorolac increases bleeding after tonsillectomy in children.
abstract: OBJECTIVE
  To compare the incidence of vomiting following codeine or ketorolac for tonsillectomy in children.
  
  
  METHODS
  We had planned to enrol 240 patients, aged 2-12 yr undergoing elective tonsillectomy into a randomized, single-blind study in University Children's Hospital. The study was terminated, after 64 patients because interim analysis of the data by a blinded non-study scientist concluded that the patients were at undue risk of excessive perioperative bleeding. After induction of anaesthesia by inhalation with N2O/halothane or with propofol 2.5-3.5 mg.kg-1 i.v., the children were administered 150 micrograms.kg-1 ondansetron and 50 micrograms.kg-1 midazolam. Maintenance of anaesthesia was with N2O and halothane in O2. Subjects were administered either 1.5 mg.kg-1 codeine im or 1 mg.kg-1 ketorolac i.v. before the commencement of surgery. Intraoperative blood loss was measured with a Baxter Medi-Vac Universal Critical Measurement Unit. Postoperative management of vomiting and pain was standardized. Vomiting was recorded for 24 hr after anaesthesia. Data were compared with ANOVA, Chi-Square analysis and Fisher Exact Test.
  
  
  RESULTS
  Thirty-five subjects received ketorolac. Demographic data were similar. The incidence of vomiting during the postoperative period was 31% in the codeine-group and 40% in the ketorolac-group. Intraoperative blood losses was 1.3 +/- 0.8 ml.kg-1 after codeine and 2.2 +/- 1.9 ml.kg-1 after ketorolac (mean +/- SD) P < 0.05. Five ketorolac-treated patients had bleeding which led to unscheduled admission to hospital, P < 0.05, Exact Test.
  
  
  CONCLUSIONS
  Preoperative ketorolac increases perioperative bleeding among children undergoing tonsillectomy without beneficial effects.
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: E J
authors.initials: EJ
authors.lastname: Rhine
authors.forename: D W
authors.initials: DW
authors.lastname: Roberts
authors.forename: C W
authors.initials: CW
authors.lastname: Reid
authors.forename: H B
authors.initials: HB
authors.lastname: MacNeill
mesh_terms: D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000704:Analysis of Variance; D000769:Anesthesia, Inhalation; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D000932:Antiemetics / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D016063:Blood Loss, Surgical; D002648:Child; D002675:Child, Preschool; D003061:Codeine / Q000008:administration & dosage / Q000627:therapeutic use; D017558:Elective Surgical Procedures; D006221:Halothane / Q000008:administration & dosage; D006801:Humans; D020910:Ketorolac; D008874:Midazolam / Q000008:administration & dosage; D009609:Nitrous Oxide / Q000008:administration & dosage; D017294:Ondansetron / Q000008:administration & dosage / Q000627:therapeutic use; D006472:Oral Hemorrhage / Q000209:etiology*; D019106:Postoperative Hemorrhage / Q000209:etiology*; D011292:Premedication; D015742:Propofol / Q000008:administration & dosage; D016037:Single-Blind Method; D014046:Tolmetin / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D014068:Tonsillectomy; D014839:Vomiting / Q000517:prevention & control
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D000932:Antiemetics; D017294:Ondansetron; D014046:Tolmetin; D009609:Nitrous Oxide; D008874:Midazolam; D006221:Halothane; D003061:Codeine; D015742:Propofol; D020910:Ketorolac