Fujii Y
Current management of vomiting after tonsillectomy in children. [Journal Article, Review]
Curr Drug Saf 2009 Jan; 4(1):62-73.
Postoperative vomiting (POV) continues to be a common complication in children undergoing tonsillectomy with or without adenoidectomy. The incidence of POV is between 62% and 73% when no prophylactic antiemetic is given. Numerous antiemetics have been studied for the management of POV after pediatric tonsillectomy. As traditional antiemetics, benzamides (e.g., metoclopramide), butyrophenones (e.g., droperidol), phenothiazines (e.g., perphenazine), and antihistamines (e.g., dimenhydrinate) are used for POV. The available nontraditional antiemetics are propofol, dexamethasone, and midazolam. Serotonin receptor antagonists, which include ondansetron, granisetron, tropisetron, dolasetron, and ramosetron, are more effective than traditional antiemetics. However, these drugs are not entirely effective, perhaps because most of them act through the blockade on one type of receptor. Combination antiemetic therapy with a serotonin receptor antagonist (ondansetron, granisetron, tropisetron) plus droperidol or dexamethasone is highly effective for the prophylaxis against POV. Nonpharmacological techniques include acustimulation, acupressure, and acupuncture at P6 (Nei-Kuwan) point. Most of published trials indicate an improved antiemetic prophylaxis in children undergoing tonsillectomy with or without adenoidectomy when risk factors for POV would be avoided and/or effective antiemetic therapy would be performed. For the prevention of POV after pediatric tonsillectomy, baseline risk factors, including patient characteristics, surgical procedure, anesthetic techniques, and postoperative care, should be avoided, if possible. Clinicians should also consider these clinical strategies as mentioned above for the prevention of POV after tonsillectomy in children.
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