Ondansetron dose response curve in high-risk pediatric patients

Lawhorn, C. David; Kymer, Patti J.; Stewart, Frank C.; Stoner, Jo Anne M.; Shirey, Robert; Volpe, Paula

doi:10.1016/s0952-8180(97)00194-3

Cited by 21 publications

(11 citation statements)

References 18 publications

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“…Intravenous ondansetron 0.05 mg/kg Similarly, another study [55] concluded that nitrous oxide in combiwas determined to be the lowest effective dose. [66] Prophylactic nation with sevoflurane was not associated with an increase in ondansetron 0.1 mg/kg (up to a total dose of 4mg) reduced POV in POV; the incidence of POV for the nitrous oxide and no nitrous pediatric patients regardless of surgical or anesthesia factors.…”

Section: Ondansetronmentioning

confidence: 95%

“…Splinter and Komocar [54] combined with dexamethasone. In several large, dose-ranging, and studied the effects of nitrous oxide on POV in children who placebo-controlled trials, [63][64][65][66][67] intravenous ondansetron 0.05-0.15 underwent outpatient dental restorations under halothane anesthemg/kg or oral ondansetron 0.1 mg/kg was significantly more sia. Even though the POV rate in the PACU was slightly less for effective than placebo for the prevention of emesis in children the no nitrous oxide versus the nitrous oxide group (15% vs 24%), undergoing highly emetogenic surgery, which included tonsillecthey concluded that nitrous oxide did not significantly affect POV.…”

Section: Ondansetronmentioning

confidence: 99%

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Management of Postoperative Nausea and Vomiting in Children

Kovac

2007

Pediatric Drugs

115

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Postoperative nausea and vomiting (PONV) continues to be a frequent and important cause of morbidity in children. Postoperative vomiting (POV) is more commonly studied in children than postoperative nausea because of a child's inability to effectively express distress after experiencing nausea. POV is problematic in children and is one of the leading postoperative complaints from parents and the leading cause of readmission to the hospital. POV occurs twice as frequently in children as in adults, increasing until puberty and then decreasing to adult incidence rates. Gender differences are not seen before puberty. POV remains a main cause of morbidity in children because severe vomiting can be associated with dehydration, postoperative bleeding, pulmonary aspiration, and wound dehiscence. While children have an increased potential for dehydration and the resulting physiologic impairments, other associated results such as a delay in hospital discharge or an overnight or longer hospital admission also must be considered. The two most common emetogenic surgical procedures evaluated in children are strabismus repair and adenotonsillectomy. The approach to the management of PONV and POV in children is similar to that in adults. However, as the rate of POV is more frequent in children than in adults, more children are candidates for antiemetic prophylaxis. The management approach is multifactorial and involves proper preoperative preparation, risk stratification, rational selection of antiemetic prophylaxis, choice of anesthesia technique, and a plan for postoperative antiemetic therapy. It is important to identify children at moderate-to-high risk for POV as prophylactic antiemetic therapy is useful in these children. Antiemetics of choice for POV in children include dexamethasone, dimenhydrinate, perphenazine, ondansetron, dolasetron, granisetron, and tropisetron. The serotonin (5-hydroxytryptamine; 5-HT(3)) antagonists are the antiemetic drugs of first choice for POV prophylaxis in children because as a group they have greater efficacy for preventing vomiting than nausea. The 5-HT(3) antagonists can be effectively combined with dexamethasone with an increase in efficacy. If possible, regional anesthesia should be considered. For those undergoing general anesthesia, the baseline POV risk should be reduced. Children at moderate-to-high PONV risk should receive combination therapy with two or three prophylactic antiemetics from different antiemetic drug classes. Reference to and the use of PONV guidelines and management algorithms help improve cost-effective postoperative care.

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Section: Ondansetronmentioning

confidence: 95%

Section: Ondansetronmentioning

confidence: 99%

Management of Postoperative Nausea and Vomiting in Children

Kovac

2007

Pediatric Drugs

115

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“…[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.…”

Section: Ondansetronmentioning

confidence: 92%

Management of Postoperative Nausea and Vomiting in Children

Negri

Ivani

2002

Pediatric Drugs

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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.

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“…The lowest effective dose in pediatric patients was found to be 0.05 mg/kg [21]. Several pediatric ondansetron studies have confirmed its safety and effectiveness in POV prophylaxis [22–27].…”

Section: Adult and Pediatric Patients: Current Treatment Optionsmentioning

confidence: 99%

Prophylaxis of Postoperative Nausea and Vomiting in Adolescent Patients: A Review with Emphasis on Combination of Fixed-Dose Ondansetron and Transdermal Scopolamine

Pergolizzi

Raffa

Taylor

2011

Journal of Drug Delivery

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Postoperative nausea and vomiting (PONV) is a relatively common occurrence (20–30%) that delays discharge and, if persistent, can lead to serious complications. The incidence of PONV is a function of patient characteristics, the type and duration of surgery, the type of anesthesia, and the choice of pre-, intra-, and postoperative pharmacotherapy. There are no completely effective antiemetic agents for this condition, but recommendations for treatment strategies are separately available for pediatric and adult patients. Left unclear is whether adolescents should be guided by the pediatric or the adult recommendations. We review the developmental physiology of the relevant physiological factors (absorption, distribution, metabolism, and elimination). We also review the clinical evidence regarding the safety and efficacy of a fixed-dose combination of ondansetron (4 mg, i.v.) and transdermal scopolamine (1.5 mg).

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Ondansetron dose response curve in high-risk pediatric patients

Cited by 21 publications

References 18 publications

Management of Postoperative Nausea and Vomiting in Children

Management of Postoperative Nausea and Vomiting in Children

Management of Postoperative Nausea and Vomiting in Children

Prophylaxis of Postoperative Nausea and Vomiting in Adolescent Patients: A Review with Emphasis on Combination of Fixed-Dose Ondansetron and Transdermal Scopolamine

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