Effects of Ondansetron on Emesis in the First 24 Hours After Craniotomy in Children

Abstract

Children undergoing neurosurgical resection are at high risk for postoperative nausea and vomiting. Ondansetron, a selective serotonergic (5-HT3) antagonist, is effective in reducing postoperative vomiting in several high-risk populations. In a prospective, randomized study, we compared the prophylactic use of intravenous ondansetron, 0.15 mg/kg, versus placebo for the prevention of emesis in 60 children, aged 2-18 yr, undergoing craniotomies for resective procedures. Patients with preoperative emesis were excluded from the study. All patients were tracheally extubated at the conclusion of surgery, and each episode of emesis during the first 24 postoperative hours was recorded. For the entire 24-h interval, the incidence of emesis in children who received ondansetron (57%) was not significantly different from that in those who received placebo (66%); however, in the first 8 h, the incidence was 25% (ondansetron) vs 44% (placebo) (P = not significant). In those receiving placebo, there was no difference in emesis between patients undergoing operations above versus below the tentorium. Although our sample size was too small to completely exclude any beneficial effect, ondansetron appears ineffective in preventing postoperative emesis in this patient population.

The Effect of Gabapentin Premedication on Postoperative Nausea, Vomiting, and Pain in Patients on Preoperative Dexamethasone Undergoing Craniotomy for Intracranial Tumors

“…2 Severe PONV can also cause dehydration, electrolyte and acid-base imbalances, and even increase the risk of aspiration, especially in the early postoperative period when sensorium and airway reflexes tend to be depressed. [4][5][6] PONV also delays the duration of hospital discharges 7 and adds to the overall costs. 8 In addition, the incidence of moderate to severe postcraniotomy pain is 60% to 84%, which is often undertreated in this subset of patients.…”

Prognostic Models and Risk Scores: Can We Accurately Predict Postoperative Nausea and Vomiting in Children after Craniotomy?

“…7 This incidence places craniotomy with other high-risk procedures for POV in children. For example, there was a recent estimate of 52% for POV after strabismus repair 8 and another of 56% for POV after tonsillectomy.…”

The Efficacy of 5-HT3 Receptor Antagonists for the Prevention of Postoperative Nausea and Vomiting After Craniotomy: A Meta-Analysis

“…Eleven of these abstracts meet our criteria for full text review, 7 studies were ultimately included in the meta-analysis. Of the 4 excluded studies, one did not have a placebo arm 25 ; another was conducted using a pediatric population 26 ; and a third had one group receiving a combined regimen of intraoperative and postoperative ondansetron and one group receiving a placebo. 27 The third excluded study design did not have an intraoperative ondansetron alone arm that could be used in our meta-analysis.…”