Single-Dose Ondansetron Prevents Postoperative Vomiting in Pediatric Outpatients

MSN~I * Department of Anesthesiology, Children’s National Medical Center and George Washington University Medical Center, Washington, District of Columbia; t Department of Anesthesiology, Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania; $ Department of Anesthesiology, Children’s Hospital and Medical Center, Seattle, Washington; 5 Department of Anesthesiology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; 11 Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut; and ‘i[ Glaxo Wellcome Inc., Research Triangle Park, North Carolina This randomized, double-blind, parallel-group, multi- center study evaluated the safety and efficacy of ondan- setron (0.1 mg/kg to 4 mg intravenously) compared with placebo in the prevention of postoperative vomit- ing in 429 ASA status I-III children 1-12 yr old under- going outpatient surgery under nitrous oxide- and halothane-based general anesthesia. The results show that during both the 2-h and the 24-h evaluation periods after discontinuation of nitrous oxide, a significantly greater percentage of ondansetron-treated patients (2 h 89%, 24 h 68%) compared with placebo-treated patients (2 h 71%, 24 h 40%) experienced complete response (i.e., no emetic episodes, not rescued, and not withdrawn; P < 0.001 at both time points). Ondansetron-treated pa- tients reached criteria for home readiness one-half hour sooner than placebo-treated patients (P < 0.05). The age of the child, use of intraoperative opioids, type of sur- gery, and requirement to tolerate fluids before dis- charge may also have affected the incidence of postop- erative emesis during the 0- to 24-h observation period. Use of postoperative opioids did not have any effect on complete response rates in this patient population. We conclude that the prophylactic use of ondansetron re- duces postoperative emesis in pediatric patients, re- gardless of the operant influential factors. Implica- tions: Postoperative nausea and vomiting often occur after surgery and general anesthesia in children and are the major reason for unexpected hospital admission af- ter ambulatory surgery. Our study demonstrates that the prophylactic use of a small dose ondansetron re- duces postoperative vomiting in pediatric patients. (Anesth Analg 1997;85:53845)