Retrospective review of three antiemetic regimens versus no therapy in the prevention of postoperative and vomiting following adenotonsillar surgery

摘要

Objective: To study the effect of intraoperative ondansetron and dexamethasone on postoperative vomiting in children undergoing tonsillectomy, adenotonsillectomy, or adenoidectomy. Study Design: Retrospective chart review. Setting: Academic tertiary care referral centre in the west of Scotland. Subjects and Methods: A retrospective chart review was conducted on 432 children admitted to our institute between 2004 and 2006. Of these, 285 (66%) patients underwent a tonsillectomy, 50 (11.6%) an adenotonsillectomy, and 97 (22.4%) an adenoidectomy. There was an equal gender distribution, with a mean age of 7.4 years (interquartile range 4.6-10.0). Patients were divided into four groups: group 1 received ondansetron plus dexamethasone (n = 64, 14.7%), group 2 received ondansetron only (n = 189, 43.6%), group 3 received dexamethasone only (n = 17, 3.9%), and group 4 did not receive ondansetron or dexamethasone (n = 162, 37.4%). Results: Overall, 98 (22.7%) patients experienced postoperative vomiting (5 at the time of recovery and 93 on the ward). Patients in group 1 had a significantly lower incidence of postoperative vomiting than those in group 2 (10.9% vs 22.8%, p = .04) and group 4 (10.9% vs 27.2%, p < .01). The incidence of postoperative vomiting was also lower in group 1 than in group 3, but this did not reach statistical significance (10.9% vs 23.5%, p = .18). Conclusion: The combined intraoperative use of ondansetron and dexamethasone appears to be superior to no antiemetic or ondansetron alone in reducing the incidence of vomiting in children undergoing adenotonsillar surgery.