A comparison of the costs and efficacy of ondansetron and dolasetron in the prophylaxis of postoperative vomiting in pediatric patients undergoing ambulatory surgery.
Postoperative vomiting (POV) after ambulatory surgery remains a major problem. We designed this study to determine the smallest dose of dolasetron equivalent to the Food and Drug Administration approved dose of ondansetron 100 micro g/kg IV, for the prophylaxis of POV in children undergoing surgery. In this double-blinded controlled study, 204 healthy ASA I-II children aged 2-12 yr, undergoing superficial ambulatory (day-case) surgery, were randomized to receive either ondansetron 100 micro g/kg IV, or dolasetron 45, 175, 350, or 700 micro g/kg IV during a standardized perioperative regimen. The primary end-point was the incidence of complete response, defined as the absence of POV symptoms. Costs were calculated from the perspective of the hospital using a previously described model. The incidence of early (0-6 h) and 24-h emesis was more frequent in the dolasetron 45 micro g/kg group compared with the dolasetron 350 and 700 micro g/kg groups and with the ondansetron group. Repeated POV occurred more often when dolasetron was used in a dose <350 micro g/kg. There were no significant differences in emesis rates between the dolasetron 175, 350, and 700 micro g/kg groups or between these groups and the ondansetron 100 micro g/kg group. The smallest dose of dolasetron with acceptable equivalent efficacy and patient satisfaction scores to ondansetron 100 micro g/kg was 350 micro g/kg. Institutional costs for managing POV were less with dolasetron 350 micro g/kg than with ondansetron.


CONCLUSIONS
This randomized double-blinded dose-ranging study concluded that dolasetron, 350 micro g/kg IV, was the smallest dose that provided acceptable equivalent efficacy and patient satisfaction scores to ondansetron, 100 micro g/kg IV, for the prophylaxis of postoperative vomiting in children undergoing outpatient surgery. However, with this dose, the costs to the institution for managing postoperative vomiting were less.
Olutoye
Olutoyin
O
Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania.
Jantzen
Ellen C
EC
Alexis
Rhonda
R
Rajchert
Donna
D
Schreiner
Mark S
MS
Watcha
Mehernoor F
MF
D000556:Ambulatory Surgical Procedures / Q000191:economics; D000768:Anesthesia, General; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D016527:Drug Costs; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007211:Indoles / Q000008:administration & dosage* / Q000191:economics; D008297:Male; D017294:Ondansetron / Q000008:administration & dosage* / Q000191:economics; D020250:Postoperative Nausea and Vomiting / Q000191:economics / Q000517:prevention & control*; D011807:Quinolizines / Q000008:administration & dosage* / Q000191:economics
D007211:Indoles; D011807:Quinolizines; D017294:Ondansetron; C060344:dolasetron