Tonsillectomy and Postoperative Vomiting

Shott, Sally R.

doi:10.1001/archotol.127.8.1009

Cited by 10 publications

(4 citation statements)

References 7 publications

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“…However, randomized controlled studies are needed to find out the safety and efficacy of repeated doses. [2]…”

Section: Discussionmentioning

confidence: 99%

“…However, randomized controlled studies are needed to find out the safety and efficacy of repeated doses. [2] Henzi I, Walder B, Tramer MR did meta-analysis of 17 trials involving use of dexamethasone for prevention of postoperative nausea and vomiting in surgical patients. The number needed to treat to prevent early and late vomiting compared with placebo in adults and children was 7.1 (95%CL 4.5 to 18) and 3.8 (2.9 to 5) respectively, They concluded that when there is a high risk of postoperative nausea and vomiting, a single prophylactic dose of dexamethasone is anti-emetic compared with placebo, without evidence of any clinically prevalent toxicity in otherwise healthy patients.…”

Section: Discussionmentioning

confidence: 99%

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A prospective study to compare the effects of pre,intra and post operative steroid (dexamethasone sodium phosphate) on post tonsillectomy morbidity

Thimmasettaiah¹,

Chandrappa²

2012

Journal of Pharmacology and Pharmacotherapeutics

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Objective:To determine the effectiveness of dexamethasone on post tonsillectomy morbidities in patients with chronic tonsillitis.Materials and Methods:In this randomized double-blind study, 100 patients who underwent tonsillectomy were enrolled and were randomly allocated into control or dexamethasone group (pre operative, intra operative and post operative groups). Patients were assessed for pain nausea, vomiting and oral intake in the post operative period at 24 h.Results:Patients treated with dexamethasone particularly in the pre and intra operative groups (Group B, Group C) showed a general trend towards lower pain score than post operative group (Group D). The scores were about 1.72±0.84 and 2.20±1.19 in Groups B and C respectively, and 2.64±0.99 in Group D. Overall pain score was found to be more in the control Group A about 4.84±1.21 at 6 h post operatively and showed similar trend for next 24 h. Total number of patients with nausea was significantly high about 84% in control group compared to dexamethasone groups (Group B, C and D) about 20%, 8% and 24% respectively and also incidence of vomiting episodes showed a similar trend. Oral intake was significantly delayed in control group (6.16 ±1.52), P < 0.001 than dexamethasone group. Pre operative and intra operative groups showed early intake (3.68±0.68) and (3.60±1.12) respectively than the postoperative group (5.08±0.95).Conclusions:A single intravenous dose of dexamethasone, given following induction of anaesthesia and at the time of surgery, provided prolonged analgesia, reduced nausea and vomiting and resulted in earlier oral intake.

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“…However, randomized controlled studies are needed to find out the safety and efficacy of repeated doses. [2]…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A prospective study to compare the effects of pre,intra and post operative steroid (dexamethasone sodium phosphate) on post tonsillectomy morbidity

Thimmasettaiah¹,

Chandrappa²

2012

Journal of Pharmacology and Pharmacotherapeutics

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“…Vosdoganis and Baines [151] similarly effect in ENT surgery, [144] numerous studies [52,144,[147][148][149][150][151][152] have evaldetermined that dexamethasone substantially reduced POV after uated the effectiveness of corticosteroids for POV following tontonsillectomy. sillectomy.…”

Section: Ramosetron Versus Granisetronmentioning

confidence: 99%

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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“…Several studies regarding the effect of a single preoperative I.V dose of steroid on the morbidity of tonsillectomy has been reported different results (18,19). Many reports have found that preoperative administration of a single dose of I.V steroid have reduced the postoperative pain, emesis with an earlier return to normal oral intake feeding (20)(21)(22).…”

Section: Discussion:-mentioning

confidence: 99%

Efficacy of Preoperative Administration of Metoclopramide and Dexamethasone in Preventing Vomiting in Children Undergoing Tonsillectomy

Abutineh¹,

Samawi²,

Mattar³

et al. 2016

IJAR

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To carry out a comparative study between metoclopramide and dexamethasone to find out its effect by the way of preoperative administration on the rate of postoperative emesis in children who undergoing tonsillectomy. Patients and Methods: Ninety patients between the age of 3-14 years who planned for tonsillectomy were enrolled in our study. Patients were randomly divided into three main groups: Group I: In which children received Dexamethasone injection with a dose of 0.15 mg/kg IV (n = 30). Group II: In which children received Metoclopramide injection with a dose of 0.15 mg/kg IV (n = 30). Group III: In which children received 4 ml saline (n = 30). All episodes of Postoperative vomiting were recorded Results: There were no significant differences between these three main groups of patients regarding the age, sex, weight, type of surgery, duration of surgery and duration of anesthesia. The incidence of vomiting throughout the initial four hours (0-4 hours) was not wasn't considerably different between the three groups, three patients (10%) in the dexamethasone group compared with 3 patients (10%) in the metoclopramide group and 4 patients (13%) in the saline group (P < 0.05). The incidence of vomiting during (4-24 hours) was more frequent in the saline group, 8 patients (27%) developed vomiting (P < 0.001). Only three (10%) patients in the metoclopramide group vomited during this period compared with 6 patients (20%) in the dexamethasone group Conclusion: Metoclopramide found to be more effective than dexamethasone in preventing vomiting in children undergoing tonsillectomy.

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Tonsillectomy and Postoperative Vomiting

Cited by 10 publications

References 7 publications

A prospective study to compare the effects of pre,intra and post operative steroid (dexamethasone sodium phosphate) on post tonsillectomy morbidity

A prospective study to compare the effects of pre,intra and post operative steroid (dexamethasone sodium phosphate) on post tonsillectomy morbidity

Management of Postoperative Nausea and Vomiting in Children

Efficacy of Preoperative Administration of Metoclopramide and Dexamethasone in Preventing Vomiting in Children Undergoing Tonsillectomy

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