title: Tropisetron plus subhypnotic propofol infusion is more effective than tropisetron alone for the prevention of vomiting in children after tonsillectomy.
abstract: This study evaluated the efficacy of tropisetron compared with tropisetron and a subhypnotic propofol infusion in preventing postoperative vomiting following tonsillectomy. One hundred and forty healthy children, aged four to 12 years, undergoing tonsillectomy were recruited in a randomised, double-blind study. After induction with sevoflurane, anaesthesia was maintained with sevoflurane and nitrous oxide. All patients received tropisetron (0.2 mg/kg up to 5 mg; intravenously) and fentanyl (2 microg/kg; intravenously) and were intubated after atracurium which was reversed with neostigmine (and atropine). The tropisetron-plus-propofol group received a single dose of propofol (1 mg/kg) before intubation and a continuous infusion of propofol throughout surgery at 15 microg/kg/min. Data for postoperative vomiting were grouped into zero to four and four to 24 hour time intervals. A P value of < 0.05 was considered statistically significant. The percentage of patients exhibiting a complete response (no retching or vomiting for 24 hours) was 47.1% (33/70) in the tropisetron-alone group and 72.8% (51/70) in the tropisetron-plus-propofol group (P = 0.002). The 0.257 absolute risk reduction of vomiting with the addition of propofol represents a number needed to treat of 3.87, and a risk ratio of 0.51 (95% CI 0.32 to 0.79). Significantly fewer patients vomited in the tropisetron-plus-propofol group than in the tropisetron-alone group during the zero to four post-surgery interval (P = 0.016), but the difference was not statistically significant for the four to 24 hour postoperative period (P = 0.116). Intraoperative subhypnotic propofol infusion combined with tropisetron is more effective than tropisetron alone in reducing postoperative vomiting after tonsillectomy in children.
authors.affiliation: Department of Anaesthesiology and Reanimation, Medical Faculty, Ataturk University, Erzurum , Turkey.
authors.forename: A F
authors.initials: AF
authors.lastname: Erdem
authors.forename: O
authors.initials: O
authors.lastname: Yoruk
authors.forename: F
authors.initials: F
authors.lastname: Silbir
authors.forename: H A
authors.initials: HA
authors.lastname: Alici
authors.forename: M
authors.initials: M
authors.lastname: Cesur
authors.forename: N
authors.initials: N
authors.lastname: Dogan
authors.forename: B
authors.initials: B
authors.lastname: Aktan
authors.forename: Y
authors.initials: Y
authors.lastname: Sutbeyaz
mesh_terms: D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D000932:Antiemetics / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007211:Indoles / Q000008:administration & dosage*; D008297:Male; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control*; D015742:Propofol / Q000008:administration & dosage*; D011446:Prospective Studies; D014068:Tonsillectomy; D016896:Treatment Outcome; D000077526:Tropisetron
chemical_list: D018686:Anesthetics, Intravenous; D000932:Antiemetics; D007211:Indoles; D000077526:Tropisetron; D015742:Propofol