Ondansetron dose response curve in high-risk pediatric patients.
OBJECTIVE
To establish a dose-response relationship for ondansetron, and to evaluate any effects of oral premedication with metoclopramide in pediatric patients undergoing tonsillectomy and adenoidectomy and strabismus surgery.


METHODS
Prospective, randomized, double blind study.


METHODS
University affiliated, 280-bed pediatric hospital.


METHODS
320 ASA physical status l and II patients between the ages of 2 and 12 years undergoing tonsillectomy and adenoidectomy or strabismus surgery.


METHODS
Patients were randomized to eight investigational groups. Patients in all eight groups underwent a standard anesthetic. Groups 1, 2, 3, and 4 received intravenous (i.v.) saline or i.v. ondansetron at doses of 0.05 mg/kg, 0.1 mg/kg and 0.15 mg/kg, respectively. Groups 5, 6, 7, and 8 received oral metoclopramide 0.15 mg/kg as well as i.v. saline, and ondansetron 0.05 mg/kg, 0.1 mg/kg, or 0.15 mg/kg. Patients were evaluated for emetic episodes prior to and following discharge.


RESULTS
All doses of ondansetron 0.05 mg/kg, 0.1 mg/kg, and 0.15 mg/kg were significantly more effective than placebo in reducing the incidence of emesis prior to, following discharge, and during the first 24 postoperative hours (p < 0.001). There were no significant differences in the occurrence of emesis between the groups receiving ondansetron 0.05 mg/kg, 0.1 mg/kg, and 0.15 mg/kg. The addition of oral metoclopramide 0.15 mg/kg had no effect on the incidence of emesis in the ondansetron or placebo study groups.


CONCLUSIONS
Ondansetron is an effective medication for the treatment and prevention of postoperative nausea and vomiting, and a dose of ondansetron 0.05 mg/kg is as effective as 0.1 mg/kg and 0.15 mg/kg. Metoclopramide 0.15 mg/kg has no effect on the incidence of postoperative nausea and vomiting.
Lawhorn
C D
CD
Division of Pediatric Anesthesia, Arkansas Children's Hospital, Little Rock 72202-3591, USA.
Kymer
P J
PJ
Stewart
F C
FC
Stoner
J M
JM
Shirey
R
R
Volpe
P
P
D000233:Adenoidectomy; D000932:Antiemetics / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008787:Metoclopramide / Q000627:therapeutic use; D009325:Nausea / Q000517:prevention & control*; D017294:Ondansetron / Q000008:administration & dosage / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000517:prevention & control*; D012307:Risk Factors; D013285:Strabismus / Q000601:surgery; D014068:Tonsillectomy; D014839:Vomiting / Q000517:prevention & control*
D000932:Antiemetics; D017294:Ondansetron; D008787:Metoclopramide