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Aggressive Prophylactic Treatments for Postoperative Nausea and Vomiting Improve Outcomes in Pediatric Adenotonsillectomy Procedure.
J Pediatr Pharmacol Ther. 2020; 25(4):303-308.JP

Abstract

OBJECTIVE

Postoperative 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.

METHODS

In 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.

RESULTS

Overall 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).

CONCLUSION

Aggressive 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.

Authors

No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32461743

Citation

Demidovich, Tatyana, et al. "Aggressive Prophylactic Treatments for Postoperative Nausea and Vomiting Improve Outcomes in Pediatric Adenotonsillectomy Procedure." The Journal of Pediatric Pharmacology and Therapeutics : JPPT : the Official Journal of PPAG, vol. 25, no. 4, 2020, pp. 303-308.
Demidovich T, Perez-Franco O, Silvestrini-Suarez M, et al. Aggressive Prophylactic Treatments for Postoperative Nausea and Vomiting Improve Outcomes in Pediatric Adenotonsillectomy Procedure. J Pediatr Pharmacol Ther. 2020;25(4):303-308.
Demidovich, T., Perez-Franco, O., Silvestrini-Suarez, M., & Yue, P. (2020). Aggressive Prophylactic Treatments for Postoperative Nausea and Vomiting Improve Outcomes in Pediatric Adenotonsillectomy Procedure. The Journal of Pediatric Pharmacology and Therapeutics : JPPT : the Official Journal of PPAG, 25(4), 303-308. https://doi.org/10.5863/1551-6776-25.4.303
Demidovich T, et al. Aggressive Prophylactic Treatments for Postoperative Nausea and Vomiting Improve Outcomes in Pediatric Adenotonsillectomy Procedure. J Pediatr Pharmacol Ther. 2020;25(4):303-308. PubMed PMID: 32461743.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Aggressive Prophylactic Treatments for Postoperative Nausea and Vomiting Improve Outcomes in Pediatric Adenotonsillectomy Procedure. AU - Demidovich,Tatyana, AU - Perez-Franco,Orlando, AU - Silvestrini-Suarez,Marco, AU - Yue,Pin, PY - 2020/5/29/entrez PY - 2020/5/29/pubmed PY - 2020/5/29/medline KW - adenoidectomy KW - dexamethasone KW - diphenhydramine KW - ondansetron KW - pediatric KW - postoperative nausea and vomiting KW - scopolamine KW - tonsillectomy SP - 303 EP - 308 JF - The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG JO - J Pediatr Pharmacol Ther VL - 25 IS - 4 N2 - OBJECTIVE: Postoperative 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. METHODS: In 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. RESULTS: Overall 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). CONCLUSION: Aggressive 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. SN - 1551-6776 UR - https://www.unboundmedicine.com/medline/citation/32461743/Aggressive_Prophylactic_Treatments_for_Postoperative_Nausea_and_Vomiting_Improve_Outcomes_in_Pediatric_Adenotonsillectomy_Procedure DB - PRIME DP - Unbound Medicine ER -
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