ArticleThe journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG2020
Aggressive Prophylactic Treatments for Postoperative Nausea and Vomiting Improve Outcomes in Pediatric Adenotonsillectomy Procedure.
Article in The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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2 citing papers in PubMed, 4 citations in OpenAlex.
- Comparative Analysis of Preoperative Sedation Modalities: Oral Midazolam and Ketamine Versus Chloral Hydrate and Meperidine in Pediatric Tonsillectomy - A Randomized Clinical Trial.Turkish archives of otorhinolaryngology · 2025Article
- Postoperative Nausea and Vomiting in Pediatric Patients.Paediatric drugs · 2021Review
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4 authors.
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No grant is acknowledged in the PubMed record.
Abstract
objectivePostoperative nausea and vomiting (PONV) is an extremely common side effect of general anesthesia that is difficult to manage. We tested a hypothesis that an aggressive prophylactic intervention with additional antiemetic drugs will reduce the incidence of PONV in a high-risk pediatric population undergoing adenotonsillectomy.
methodsIn this retrospective study, pediatric patients undergoing adenotonsillectomy were screened for their risk factors for PONV. Patients who had 3 or more risk factors were identified as high risk and received either scopolamine patch preoperatively (for patients over 40 kg body weight) or diphenhydramine immediately postextubation in addition to ondansetron and dexamethasone, which are given routinely. Incidences of PONV within the first 60 minutes of a postanesthesia care unit (PACU) stay were collected and analyzed.
resultsOverall postoperative vomiting rates during the first hour of a PACU stay were 4.3% for the group that was treated with dexamethasone and ondansetron only and 3.9% for the group that was treated with additional antiemetic drugs. Aggressive prophylactic management of PONV did reduce the rate of nausea and vomiting in a group of high-risk patients (p < 0.0001). The postoperative antiemetic drug usage was also decreased during the first 60 minutes of a PACU stay. However, the approach did not reduce the overall rate of PONV for the entire study population (p = 0.1612 for nausea and p = 0.0678 for vomiting).
conclusionAggressive intraoperative management of PONV with additional antiemetic drugs are beneficial in high-risk pediatric population. Intraoperative diphenhydramine usage decreased the rate of PONV. However, preoperative scopolamine patch prevention did not improve PONV, which may be related to the drug's longer onset of action. Our result suggests that current clinical practice is undertreating PONV in pediatric patients receiving general anesthesia.
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