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A study to compare dexamethasone and ondansetron for preventing postopera-tive nausea and vomiting in children undergoing tonsillectomy

Year 2015, , 213 - 219, 18.09.2015
https://doi.org/10.7197/cmj.v37i3.5000083270

Abstract

SUMMARY

Objective: Various drugs have been used as antiemetics for treatment of postoperative nausea and vomiting. The present study was undertaken to assess the efficacy of ondansetron and dexamethasone for preventing postoperative nausea and vomiting in children undergoing tonsillectomies.

Method: Sixty children having ASA physical status Grade I or II in the age group 4-12 years undergoing tonsillectomy under general anaesthesia were included in the study. These were allocated to three groups of twenty patient each. After induction patients were given test solution A (2 mL) comprising of normal saline or dexamethasone 500 µg/kg or 150 µg/kg in Group I, II and III respectively. At the end of surgery before switching off anaesthetics, test solution B (2 mL) was given comprising of ondansetron 0.15 mg/kg (maximum upto 4 mg) or normal saline or ondansetron 0.1 mg/kg (maximum upto 2 mg). Postoperatively incidence of nausea, number of vomiting episodes, frequency of administration of rescue antiemetic and analgesic were recorded.

Results: In Group II 80% of patients had nausea as compared to 70% in Group I and 50% in group III and the difference between Group II and III was statistically significant (p<0.05). 30% of the patients had vomiting in Group I and II and only 15% of the patients in Group III. The frequency of rescue analgesic among the three groups was comparable except at 0.5 hours. 50% of patients showed complete response in Group III, as compared to 30% and 20% in Group I and Group II respectively.

Conclusion: The combined regimen of ondansetron with dexamethasone was more efficacious as an antiemetic in controlling postoperative nausea and vomiting in children undergoing tonsillectomy.

Keywords: Postoperative nausea and vomiting, dexamethasone, ondansetron, tonsillectomy

ÖZET

Amaç: Postoperatif bulantı ve kusmanın tedavisi için antiemetic olarak çeşitli ilaçlar kullanılmaktadır. Bu çalışmada tonsillektomi yapılan çocuklarda postoperative bulantı ve kusmayı önlemek için ondansetron ve deksametazonun etkinliği değerlendirilmektedir.

Yöntem: Genel anestezi altında tonsillektomi yapılan 4-12 yaşları arasında Grade I ve Grade II ASA fiziksel durumuna sahip 60 çocuk çalışmaya dahil edildi. Bunlar her biri 20’şer kişiden oluşan üç gruba ayrıldı. İndüksiyondan sonra sırasıyla Grup I, Grup II ve Grup III’deki hastalara normal salin ya da deksametazon 500 µg/kg ya da 150 µg/kg’dan oluşan test solüsyonu A (2 mL) verildi. Cerrahinin sonunda, anestezikleri “switch” yapmadan önce test solüsyonu B (2 mL) At the end of surgery before switching off anaesthetics, ondansetron 0.15 mg/kg (maksimum 4 mg) ya da normal salin ya da ondansetron 0.1 mg/kg (maksimum 2 mg)’dan oluşan test solüsyonu B (2 mL) verildi. Postoperatif bulantı ve kusma sayısı, antiemetic ve analjezik uygulama sıklığı kaydedildi.

Bulgular: Grup II’de hastaların %80’inde, Grup I’deki %70 ve Grup III’deki %50 ile karşılaştırıldığında bulantıya sahipti. Grup II ve III arasındaki fark istatistiksel olarak anlamlı idi (p<0.05). Grup I ve II’de hastaların %30’unda, Grup III’deki hastaların %15’inde kusma vardı. Her üç grupta analjezikten kurtarma sıklığı ilk yarım saatte aynı idi. Grup III’de hastaların %50’si, Grup I ve II’de ise sırasıyla %30 ve %20’si tam yanıt gösterdi.

Sonuç: Deksametazonla ondansetronun combine rejimi tonsillektomi yapılan çocuklarda posoperatif bulantı ve kusmanın kontrolünde bir antiemetik olarak daha etkilidir.

Anahtar sözcükler: Postoperatif bulantı ve kusma, deksametazon, ondansetron, tonsillektomi

References

  • -
  • Watcha MF, White PF. Postopera- tive nausea and vomiting: Its etiol- ogy, treatment and prevention. An- esthesiology 1992; 77: 162-184.
  • Koivuranta M, Laara E, Snare L, Alahukta S. A survey of postopera- tive nausea and vomiting. Anaes- thesia 1997; 52: 443-9.
  • Patel RI, Hannallah RS. Anesthetic complications following pediatric ambulatory surgery: A 3-yr study. Anesthesiology 1988; 69: 1009-12. 4.
  • Markham A, Sorkin EM. On- dansetron: Drugs 1993; 45: 931- 52. 5.
  • Jhi-Joung W, Shung-Tai H, Jann- Inn T, Chao-Shun T. The effect of timing of dexamethasone admin- istration its efficacy as a prophy- lactic antiemetic for postoperative nausea and vomiting. Anaesth An- alg 2000; 91: 136-9. 6.
  • Iris H, Benhard W, Martin TR. Dexamethasone for the prevention of postoperative nausea and vomit- ing: a quantitative systematic re- view. Anaesth Analg 2000; 90: 186-94. 7.
  • Cohen MM, Cameron CB, Duncan PG. Pediatric anesthesia morbidity and mortality in the perioperative period. Anaesth Analg 1990; 70: 160-7. 8.
  • Furst SR, Rodarte A. Prophylactic antiemetic treatment with on- dansetron in children undergoing tonsillectomy. 1994; 81: 799-803.
  • Andersen R, Krohg K. Pain as a major cause of postoperative nau- sea. Canad Anaesth Soc J 1976; 23: 366-9.
  • Stanko D, Bergesio R, Davies K, Hegarty M, von Ungern-Sternberg BS. Postoperative pain, nausea and vomiting
  • tonsillectomy-a long-term follow- up.Pediatr Anesth 2013; 23: 690-6. Sukhani R, Pappas AL, Lurie J, Hotaling AJ, Park A, Fluder E. Ondansetron and dolasetron pro- vide equivalent postoperative vom- iting control after ambulatory ton- sillectomy in dexamethasone- pre- treated children. Anesth Analg 2002; 95: 1230-5.
  • Thomas R, Jones N. Prospective randomized double-blind compara- tive study of dexamethasone, on- dansetron and ondansetron plus dexamethasone as prophylactic an- tiemetic therapy in patients under- going day-case gynaecological surgery. Br J Anaesth 2001; 87: 588-92.
  • Kushwaha B, Chakraborty A, Agarwal J, Malick A, Bhushan S, Bhattacharya P. Comparative study of granisetron and ondansetron alone and their combination with dexamethasone for prevention of PONV in middle ear surgery. In- ternet Journal of Anaesthesiology 2006; 13: 2.
  • Bano F, Zafar S, Aftab S, Haider S.
  • Eidy M, Vafaei HR, Rajabi M, Mohammadzadeh M, Pazouki A. Effect of ondansetron and dexame- thasone on post-operative nausea and vomiting in patients undergo- ing laparoscopic cholecystectomy. J Minim Invasive Surg Sci 2012; 1: 138-43.
  • Kumar A, Patodia M, Pandove PK, Sharda VK. A randomized, place- bo controlled study evaluating pre- ventive role of ondansetron, dexa- methasone and ondansetron plus dexamethasone for postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic cholecystectomy. JIMSA 2013; 26: 217-8.
  • Sun R, Klein KW, White PF. The effect of timing of ondansetron administration in outpatients un- dergoing otolaryngologic surgery. Anesth Analg 1997; 84: 331-6.
  • Figg WD, Graham CL, Hak LJ, Dukes GE. Ondansetron: A novel antiemetic agent. South Med J 1993; 86: 497-502. plus on- 15. 16. 17. 18. Goldman AC,
  • Rosenfeld RM. A meta- analysis of dexamethasone use with tonsillec- tomy. Otolaryngol Head Neck Surg 2000; 123: 682-6.
  • Bellis JR, Pirmohamed M, Nunn AJ, Loke YK, De S, Golder S. Dexamethasone and haemorrhage risk in paediatric tonsillectomy: A systematic review and meta- anal- ysis. Br J Anaesth 2014; 113: 23- 42.
  • Mahant S, Keren R, Localio R, Luan X, Song L, Shah SS. Dexa- methasone and risk of bleeding in children undergoing tonsillectomy. Otolaryngol Head Neck Surg 2014; 150: 872-9.
  • Baxendale BR, Vater M, Lavery KM. Dexamethasone reduces pain and swelling following extraction of third molar teeth. Anaesthesia 1993; 48: 961.

Tonsillektomi yapılan çocuklarda postoperative bulantı ve kusmayı önlemek için deksametazon ve ondansetronun karşılaştırmalı bir çalışması

Year 2015, , 213 - 219, 18.09.2015
https://doi.org/10.7197/cmj.v37i3.5000083270

Abstract

Amaç: Postoperatif bulantı ve kusmanın tedavisi için antiemetic olarak çeşitli ilaçlar kullanılmaktadır. Bu çalışmada tonsillektomi yapılan çocuklarda postoperative bulantı ve kusmayı önlemek için ondansetron ve deksametazonun etkinliği değerlendirilmektedir. Yöntem: Genel anestezi altında tonsillektomi yapılan 4-12 yaşları arasında Grade I ve Grade II ASA fiziksel durumuna sahip 60 çocuk çalışmaya dahil edildi. Bunlar her biri 20’şer kişiden oluşan üç gruba ayrıldı. İndüksiyondan sonra sırasıyla Grup I, Grup II ve Grup III’deki hastalara normal salin ya da deksametazon 500 µg/kg ya da 150 µg/kg’dan oluşan test solüsyonu A (2 mL) verildi. Cerrahinin sonunda, anestezikleri “switch” yapmadan önce test solüsyonu B (2 mL) At the end of surgery before switching off anaesthetics, ondansetron 0.15 mg/kg (maksimum 4 mg) ya da normal salin ya da ondansetron 0.1 mg/kg (maksimum 2 mg)’dan oluşan test solüsyonu B (2 mL) verildi. Postoperatif bulantı ve kusma sayısı, antiemetic ve analjezik uygulama sıklığı kaydedildi. Bulgular: Grup II’de hastaların %80’inde, Grup I’deki %70 ve Grup III’deki %50 ile karşılaştırıldığında bulantıya sahipti. Grup II ve III arasındaki fark istatistiksel olarak anlamlı idi (p<0.05). Grup I ve II’de hastaların %30’unda, Grup III’deki hastaların %15’inde kusma vardı. Her üç grupta analjezikten kurtarma sıklığı ilk yarım saatte aynı idi. Grup III’de hastaların %50’si, Grup I ve II’de ise sırasıyla %30 ve %20’si tam yanıt gösterdi. Sonuç: Deksametazonla ondansetronun combine rejimi tonsillektomi yapılan çocuklarda posoperatif bulantı ve kusmanın kontrolünde bir antiemetik olarak daha etkilidir

References

  • -
  • Watcha MF, White PF. Postopera- tive nausea and vomiting: Its etiol- ogy, treatment and prevention. An- esthesiology 1992; 77: 162-184.
  • Koivuranta M, Laara E, Snare L, Alahukta S. A survey of postopera- tive nausea and vomiting. Anaes- thesia 1997; 52: 443-9.
  • Patel RI, Hannallah RS. Anesthetic complications following pediatric ambulatory surgery: A 3-yr study. Anesthesiology 1988; 69: 1009-12. 4.
  • Markham A, Sorkin EM. On- dansetron: Drugs 1993; 45: 931- 52. 5.
  • Jhi-Joung W, Shung-Tai H, Jann- Inn T, Chao-Shun T. The effect of timing of dexamethasone admin- istration its efficacy as a prophy- lactic antiemetic for postoperative nausea and vomiting. Anaesth An- alg 2000; 91: 136-9. 6.
  • Iris H, Benhard W, Martin TR. Dexamethasone for the prevention of postoperative nausea and vomit- ing: a quantitative systematic re- view. Anaesth Analg 2000; 90: 186-94. 7.
  • Cohen MM, Cameron CB, Duncan PG. Pediatric anesthesia morbidity and mortality in the perioperative period. Anaesth Analg 1990; 70: 160-7. 8.
  • Furst SR, Rodarte A. Prophylactic antiemetic treatment with on- dansetron in children undergoing tonsillectomy. 1994; 81: 799-803.
  • Andersen R, Krohg K. Pain as a major cause of postoperative nau- sea. Canad Anaesth Soc J 1976; 23: 366-9.
  • Stanko D, Bergesio R, Davies K, Hegarty M, von Ungern-Sternberg BS. Postoperative pain, nausea and vomiting
  • tonsillectomy-a long-term follow- up.Pediatr Anesth 2013; 23: 690-6. Sukhani R, Pappas AL, Lurie J, Hotaling AJ, Park A, Fluder E. Ondansetron and dolasetron pro- vide equivalent postoperative vom- iting control after ambulatory ton- sillectomy in dexamethasone- pre- treated children. Anesth Analg 2002; 95: 1230-5.
  • Thomas R, Jones N. Prospective randomized double-blind compara- tive study of dexamethasone, on- dansetron and ondansetron plus dexamethasone as prophylactic an- tiemetic therapy in patients under- going day-case gynaecological surgery. Br J Anaesth 2001; 87: 588-92.
  • Kushwaha B, Chakraborty A, Agarwal J, Malick A, Bhushan S, Bhattacharya P. Comparative study of granisetron and ondansetron alone and their combination with dexamethasone for prevention of PONV in middle ear surgery. In- ternet Journal of Anaesthesiology 2006; 13: 2.
  • Bano F, Zafar S, Aftab S, Haider S.
  • Eidy M, Vafaei HR, Rajabi M, Mohammadzadeh M, Pazouki A. Effect of ondansetron and dexame- thasone on post-operative nausea and vomiting in patients undergo- ing laparoscopic cholecystectomy. J Minim Invasive Surg Sci 2012; 1: 138-43.
  • Kumar A, Patodia M, Pandove PK, Sharda VK. A randomized, place- bo controlled study evaluating pre- ventive role of ondansetron, dexa- methasone and ondansetron plus dexamethasone for postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic cholecystectomy. JIMSA 2013; 26: 217-8.
  • Sun R, Klein KW, White PF. The effect of timing of ondansetron administration in outpatients un- dergoing otolaryngologic surgery. Anesth Analg 1997; 84: 331-6.
  • Figg WD, Graham CL, Hak LJ, Dukes GE. Ondansetron: A novel antiemetic agent. South Med J 1993; 86: 497-502. plus on- 15. 16. 17. 18. Goldman AC,
  • Rosenfeld RM. A meta- analysis of dexamethasone use with tonsillec- tomy. Otolaryngol Head Neck Surg 2000; 123: 682-6.
  • Bellis JR, Pirmohamed M, Nunn AJ, Loke YK, De S, Golder S. Dexamethasone and haemorrhage risk in paediatric tonsillectomy: A systematic review and meta- anal- ysis. Br J Anaesth 2014; 113: 23- 42.
  • Mahant S, Keren R, Localio R, Luan X, Song L, Shah SS. Dexa- methasone and risk of bleeding in children undergoing tonsillectomy. Otolaryngol Head Neck Surg 2014; 150: 872-9.
  • Baxendale BR, Vater M, Lavery KM. Dexamethasone reduces pain and swelling following extraction of third molar teeth. Anaesthesia 1993; 48: 961.
There are 23 citations in total.

Details

Primary Language English
Journal Section Surgical Science Research Articles
Authors

Savita Saini

Punit Mehta

Teena Bansal

Susheela Taxak

Publication Date September 18, 2015
Published in Issue Year 2015

Cite

AMA Saini S, Mehta P, Bansal T, Taxak S. A study to compare dexamethasone and ondansetron for preventing postopera-tive nausea and vomiting in children undergoing tonsillectomy. CMJ. September 2015;37(3):213-219. doi:10.7197/cmj.v37i3.5000083270