Efficacy of ondansetron and metoclopramide for preventing postoperative emesis following strabismus surgery in children

Abstract

SummaryA double-blind, randomised, placebo-controlled trial was conducted to compare the efficacy of metoclopramide with the 5-HT 3 antagonist, ondansetron, for the prevention of postoperative emesis in children undergoing elective strabismus surgery. None of the children received any premedication and a similar anaesthetic technique was used for all. Ondansetron 0.15 mg.kg ÿ 1 , metoclopramide 0.25 mg.kg ÿ 1 or saline placebo were administered following intravenous catheter placement. Episodes of emesis were recorded for the first 24 h for the intervals of 0-2, 2-6 and 6-24 h. The incidence of emesis in the first 24 h was observed to be 71.7% in the placebo group, 34.4% in the ondansetron group (p < 0.001) and 61.4% in the metoclopramide group (p = NS). The severity of vomiting was less in the ondansetron group as compared with metoclopramide (p < 0.01) and placebo (p < 0.001). Recovery room scores were comparable in all the groups. No serious side-effects were observed in the ondansetron group. We conclude that prophylactic ondansetron is effective and superior to metoclopramide in the prevention of postoperative emesis in children following elective strabismus surgery.

Fatal Cardiac Arrest in 2 Children

“…[22][23][24][25][26][27][28][29] Other studies reported efficacy of the drug in pediatric surgical or oncology patients. [30][31][32][33][34][35][36][37][38][39] One of those studies reported mild, asymptomatic QT prolongations that remained within normal limits. 31 A literature search was performed for reports of ventricular arrhythmias, fatalities, or any type of toxicity thought to be related to ondansetron in pediatric patients.…”

Management of Postoperative Nausea and Vomiting in Children

“…[54] Other studies have shown that the antiemetic effect of ondansetron persists for up to 24 hours following surgery. [55][56][57][58][59] The incidence of late-onset PONV (>4 to 24 hours) was not influenced by prophylactic treatment with one dose of ondansetron preoperatively. [60] Ondansetron, at doses varying from 40 to 200 μg/kg, administered IV after induction in children undergoing strabismus surgery reduced the risk of vomiting, particularly in the group receiving the highest dosage.…”

Recent advances: Anaesthesia

“…Postoperative nausea and vomiting remains a significant morbidity problem after general anaesthesia and the 5-HT3 antagonists have been shown to be at least as effective as standard antiemetics but with an improved side effect profile 34 35. Postoperative nausea and vomiting remains a problem, however, and ongoing studies are investigating the efficacy of combination therapy (antagonising more than one receptor type) and the activity of the new neurokinin type 1 receptor antagonists.…”