Prophylaxis of postoperative vomiting in children undergoing tonsillectomy: a systematic review and meta-analysis.
Postoperative vomiting (POV) remains one of the commonest causes of significant morbidity after tonsillectomy in children. A variety of prophylactic anti-emetic interventions have been reported, but there has only been a limited systematic review in this patient group. A systematic search was performed by using Cochrane Controlled Trials Register, MEDLINE and EMBASE to identify double-blind, randomized, placebo-controlled trials of prophylactic anti-emetic interventions in children undergoing tonsillectomy, with or without adenoidectomy. The outcome of interest was POV in the first 24 h. Summary estimates of the effect of each prophylactic anti-emetic strategy were derived using fixed effect meta-analysis. Where appropriate, dose-response effects were estimated using logistic regression and 22 articles were identified. Good evidence was found for the prophylactic anti-emetic effect of dexamethasone [odds ratio (OR) 0.23, 95% CI 0.16-0.33], and the serotinergic antagonists ondansetron (OR 0.36, 95% CI 0.29-0.46), granisetron (OR 0.11, 95% CI 0.06-0.19), tropisetron (OR 0.15, 95% CI 0.06-0.35) and dolasetron (OR 0.25, 95% CI 0.1-0.59). Metoclopramide was also found to be efficacious (OR 0.51, 95% CI 0.34-0.77). There is not sufficient evidence to suggest that dimenhydrinate, perphenazine or droperidol, in the doses studied, are efficacious, nor were gastric aspiration or acupuncture. In conclusion, dexamethasone and the anti-serotinergic agents appear to be the most effective agents for the prophylaxis for POV in children undergoing tonsillectomy.
Bolton
C M
CM
Department of Anaesthesia and Pain Management Royal Children's Hospital and Murdoch Childrens Research Institute, Flemington Road Parkville, Melbourne, Australia 3052. chris.bolton@rch.org.au
Myles
P S
PS
Nolan
T
T
Sterne
J A
JA
D000932:Antiemetics / Q000627:therapeutic use*; D002648:Child; D004311:Double-Blind Method; D006801:Humans; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D012702:Serotonin Antagonists / Q000627:therapeutic use; D014068:Tonsillectomy
D000932:Antiemetics; D012702:Serotonin Antagonists