The effects of oral droperidol versus oral metoclopramide versus both oral droperidol and metoclopramide on postoperative vomiting when used as a premedicant for strabismus surgery

Kymer, Patti J.; Brown, Raeford E.; Lawhorn, C. David; Jones, Elizabeth V.; Pearce, Linda

doi:10.1016/0952-8180(94)00004-n

Cited by 31 publications

(8 citation statements)

References 14 publications

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“…As recently as 2002, Roberts and Jones [136] noted that PONV Numerous combination therapies [63,119,123,[128][129][130][131][132][133][134] have been following tonsillectomy continues to be a "big little problem". In compared with monotherapy for POV prophylaxis in strabismus an audit of a pediatric day-stay tonsillectomy service, Stewart patients (table VI).…”

Section: Incidence Combination Antiemeticsmentioning

confidence: 99%

“…Pandit et al [105] concluded that, for POV are recommended to receive combination therapy with although a high incidence of POV was noted, there was no two or three prophylactic antiemetics from different drug clasdifference in either the incidence or severity of POV between ses. [63,119,123,[130][131][132][133][134] children who did or did not receive nitrous oxide. Fujii et al [133] Granisetron 0.…”

Section: Anesthetic Techniquesmentioning

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: Incidence Combination Antiemeticsmentioning

confidence: 99%

Section: Anesthetic Techniquesmentioning

confidence: 99%

Management of Postoperative Nausea and Vomiting in Children

Kovac

2007

Pediatric Drugs

115

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“…Kymer et al found a combination of droperidol and metoclopramide administered as premedication per os to be efficacious in strabismus surgery. 29 Specific guidelines have been issued on the prevention and management of nausea and vomiting. 31,32 According to these guidelines, a combination of droperidol 0.625 or 1.25 mg with dexamethasone 8 mg or metoclopramide 10 mg is recommended for operative procedures associated with a high rate of nausea and vomiting, including laparoscopic procedures.…”

Section: Discussionmentioning

confidence: 99%

Prophylactic Antiemetics for Laparoscopic Cholecystectomy: Droperidol, Metoclopramide, and Droperidol plus Metoclopramide

Nesek-Adam¹,

Grizelj-Stojčić²,

Mršić³

et al. 2004

j laparoendosc adv surg tech a

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Background: Postoperative nausea and vomiting (PONV) is one of the most significant problems in laparoscopic surgery. The antiemetic effects of metoclopramide and droperidol used alone or in combination for prevention of PONV after laparoscopic cholecystectomy (LC) were assessed in this prospective, double blind, placebo controlled randomized study.Patients and Methods: A series of 140 patients, ASA physical status I or II, were included in the study. Patients were randomized to one of the following groups: 1, placebo; 2, metoclopramide 10 mg after the induction of anesthesia and placebo at 12 h postoperatively; 3, droperidol 1.25 mg after the induction of anesthesia and droperidol 1.25 mg at 12 h postoperatively; and 4, droperidol 1.25 mg plus metoclopramide 10 mg after the induction of anesthesia and droperidol 1.25 mg at 12 h postoperatively. Patients were observed for 24 hours for PONV, pain, need for rescue analgesics, and adverse events.Results: Data were analyzed using the Student's t-test and chi-square test, with P Ͻ 0.05 considered statistically significant. The mean incidence of PONV was 54% with placebo, 42% with metoclopramide, 14% with two doses of droperidol alone, and 11% with a combination of metoclopramide plus droperidol. The patients receiving a combination of metoclopramide and droperidol had a significantly lower rate of PONV than those administered metoclopramide alone (P Ͻ 0.05) or placebo (P Ͻ 0.001). Those receiving two-dose droperidol alone also had a significantly lower incidence of PONV compared with metoclopramide (P Ͻ 0.05) and placebo (P Ͻ 0.001). There was no statistically significant difference between the metoclopramide and placebo groups. Sedation was significantly greater in patients administered droperidol 12 h postoperatively.Conclusion: The combination of metoclopramide and droperidol, and two-dose droperidol alone, were found to significantly decrease the incidence of PONV after LC, whereas metoclopramide alone proved inefficient.

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“…This combination seems to represent an inexpensive alternative to the combination with the more costly ondansetron. [40,41] When droperidol 50 μg/kg IV was compared with metoclopramide 0.25 mg/kg IV and granisetron 40 μg/kg IV, prophylac-tic therapy with granisetron proved superior to both comparator agents in the prevention of PONV in children with a history of motion sickness undergoing tonsillectomy. [42] …”

Section: Droperidolmentioning

confidence: 99%

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 effects of oral droperidol versus oral metoclopramide versus both oral droperidol and metoclopramide on postoperative vomiting when used as a premedicant for strabismus surgery

Cited by 31 publications

References 14 publications

Management of Postoperative Nausea and Vomiting in Children

Management of Postoperative Nausea and Vomiting in Children

Prophylactic Antiemetics for Laparoscopic Cholecystectomy: Droperidol, Metoclopramide, and Droperidol plus Metoclopramide

Management of Postoperative Nausea and Vomiting in Children

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