Management of Postoperative Nausea and Vomiting in Children

Abstract

In spite of improvements in anesthesia techniques, the 'big little problem' of postoperative nausea and vomiting (PONV) still exists. PONV can prolong recovery room stay and hospitalization, and is one of the most common causes of hospital readmission after day surgery. While there is little evidence to support prophylactic administration of antiemetics in patients at low risk of PONV, the higher risk population could benefit from the use of adequate antiemetic drugs. A wide variety of pharmacological approaches have been reported to be effective, as well as some nonpharmacological approaches. Antiemetic drugs available to treat or prevent PONV include phenothiazines, antihistamines, anticholinergics, benzamides, butyrophenones and 5-HT(3) antagonists. Since available drugs still present undesired adverse effects and are not completely able to control PONV, clinical investigations are ongoing for more effective and better tolerated agents; indeed, the ideal antiemetic drug might be cost-effective for routine use.

Acute gastroenteritis: from guidelines to real life

“…It not only blocks the H1 receptors in the nucleus tractus solitarius, it also blocks the muscarinic-cholinergic receptors in both the vestibular apparatus and the vomiting center 43,82. Dimenhydrinate is very convenient to use because it can be given via oral, rectal, intramuscular or intravenous routes 88. The recommended dose is 1.25 mg/kg body weight, with a maximum of 50 mg 43,82.…”

“…It also has anti-cholinergic and anti-dopaminergic activities 88. Promethazine has also been used in the management of post-operative nausea and vomiting and motion sickness 57,88.…”

“…It also has anti-cholinergic and anti-dopaminergic activities 88. Promethazine has also been used in the management of post-operative nausea and vomiting and motion sickness 57,88. The medication is not expensive and can also be given orally, rectally, intramuscularly or intravenously with a doses of 0.25 mg to 1 mg/kg bodyweight (up to a maximum of 25 mg) every 4 to 6 hours as required 43.…”

“…It acts primarily as receptor antagonist and also has a D 2 parasympathomimetic activity with weak 5-HT3 receptor antagonist activity 88. It has both central and peripheral actions, and alleviates nausea and vomiting by decreasing afferent impulses to the chemoreceptor trigger zone, lowering gastric sphincter tone, stimulating gastric motility and accelerating gastric emptying and small intestine transit time.…”

The Effect of Perioperative Betamethasone on Post-operative Nausea, Vomiting and Pain in Children Undergoing Tonsillar Surgery

“…Prophylactic treatment of PONV has been shown to be effective in diminishing morbidity and increasing recovery after surgery [De Negri and Ivani, 2002]. There are several options of anti-emetic treatment, such as droperidol, ondansetron and metoclopramide, for example [Belloso et al, 2003].…”