Ondansetron versus dolasetron: a comparison study in the prevention of postoperative nausea and vomiting in patients undergoing gynecological procedures

The purpose of this study was to determine if 4 mg of ondansetron and 12.5 mg of dolasetron were equally effective in preventing postoperative nausea and vomiting (PONV) in patients undergoing gynecological procedures. While the overall incidence of PONV appears to be 25% to 35%, the incidence among this patient population is considerably higher. Patients were assigned to 1 of 2 antiemetic treatment groups. Patients in group 1 received 4 mg of ondansetron at the end of surgery, while patients in group 2 received 12.5 mg of dolasetron at the end of surgery. Data collection occurred perioperatively and in the 24 hours following surgery. chi 2 determined there was no statistical difference between groups related to emesis in the postanesthesia care unit (PACU), emesis in the 24 hours following surgery, and side effects. Results of this study showed there was no statistically significant difference between 4 mg of ondansetron or 12.5 mg of dolasetron when administered at the end of surgery for preventing PONV in patients undergoing gynecological procedures. Given the cost difference between these 2 antiemetics, there is a potential for significant cost savings in this high-risk patient population.     

Efficacy of single-dose intravenous dolasetron versus ondansetron in the prevention of postoperative nausea and vomiting.

BACKGROUND: Postoperative nausea and vomiting (PONV) is a significant problem in surgical patients. The 5-hydroxytryptamine3-receptor antagonists ondansetron, dolasetron, and granisetron are being used to prevent PONV and avoid the adverse events associated with traditional antiemetics such as antihistaminic agents, anticholinergic agents, and dopamine antagonists. OBJECTIVE: Because practitioners have taken widely differing approaches to the selection and dosing of agents in this class, this retrospective study assessed the relative efficacy of i.v. dolasetron and ondansetron in preventing PONV when used according to their approved labeling. METHODS: The medical charts of patients who underwent total abdominal hysterectomy or laparoscopic cholecystectomy and received either dolasetron 12.5 mg or ondansetron 4 mg were reviewed. Efficacy was assessed based on the number of episodes of PONV and time to the occurrence of PONV in the 24 hours after surgery. RESULTS: Of 75 medical records reviewed, 59 met the criteria for inclusion in the efficacy analysis. There were no statistically significant between-group differences in demographic or baseline clinical characteristics. The majority of patients were obese (body mass index > or = 27 kg/m2), had no history of either PONV or motion sickness, and underwent total abdominal hysterectomy. PONV occurred in 11 of 25 (44%) patients receiving dolasetron and 18 of 34 (53%) patients receiving ondansetron. Four patients receiving dolasetron experienced PONV in the first 2 hours after surgery, compared with 7 patients receiving ondansetron. CONCLUSION: There were no significant differences in efficacy between single doses of i.v. dolasetron 12.5 mg and i.v. ondansetron 4 mg in the prevention of PONV.     

A randomized, double-blind trial of palonosetron compared with ondansetron in preventing postoperative nausea and vomiting after gynaecological laparoscopic surgery

This randomized, double-blind study evaluated the relative efficacy of palonosetron (a new, selective 5-hydroxytryptamine type 3 [5-HT(3)] receptor antagonist) and ondansetron in preventing postoperative nausea and vomiting (PONV) in patients undergoing gynaecological laparoscopic surgery. Patients received either palonosetron 0.075 mg (n = 45) or ondansetron 8 mg (n = 45), intravenously, immediately before induction of general anaesthesia. The occurrence of nausea and vomiting and the severity of nausea according to a visual analogue scale were monitored immediately after the end of surgery and during the following 24 h. The incidence of PONV was significantly lower in the palonosetron group compared with the ondansetron group (42.2% vs 66.7%, respectively). There were no significant statistical differences in the visual analogue scale for nausea. In conclusion, palonosetron 0.075 mg was more effective than ondansetron 8 mg in preventing PONV.     

Biphasic dosing regimen of meclizine for prevention of postoperative nausea and vomiting in a high-risk population

The purpose of this study was to determine if giving 50 mg of meclizine the night before and on the day of surgery would effectively reduce postoperative nausea and vomiting (PONV) for the entire 24 hours after surgery in patients identified as being at high risk for PONV Subjects were randomly assigned to receive either 50 mg of oral meclizine (experimental group) or a placebo (control group) the night before and the day of surgery. All subjects were intravenously administered 4 mg of ondansetron before the conclusion of surgery. Seventy subjects (35 control; 35 experimental) were included in analysis. postoperaIn the placebo group we noted higher verbal numeric rating scale scores for nausea, a higher incidence oftive nausea and vomiting (PONV) continues to be a common complication after general anesthesia, with the incidence ranging from 17% to 87%.15 It has been reported that PONV increased antiemetic requirements, and lower overall anesthesia satisfaction scores at all time intervals measured, compared with the experimental group, but the differences were not statistically significant until analyzed by postoperative setting. No difference in sedation or side effects was noted between groups. Based on these results, we recommend that the administration of 50 mg of oral meclizine the night before and on the day of surgery be considered effective antiemetic prophylaxis in patients identified as having a high risk for PONV.     

Effects of Ondansetron and Granisetron on Postoperative Nausea and Vomiting in Adult Patients Undergoing Laparoscopic Cholecystectomy: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial

Background: Postoperative nausea and vomiting (PONV) are common and potentially distressing adverse events (AEs) associated with surgery and anesthesia. In patients undergoing laparoscopic cholecystectomy (LC) without antiemetic prophylaxis, the incidence of PONV can be as high as 72%.Objective: The aim of this study was to investigate the prophylactic antiemetic effects of ondansetron and granisetron in patients undergoing LC when these agents are administered before the end of surgery.Methods: Patients classified by the American Society of Anesthesiologist's physical status as I or II who were scheduled for elective LC were included in this randomized, double-blind, placebo-controlled study. Anesthesia was induced with thiopental 5 mg/kg and fentanyl 2 μg/kg, and was maintained with isoflurane 1% to 3% in 50% oxygen and 50% nitrous oxide and fentanyl as needed. Approximately 20 to 30 minutes before the end of the surgery, the patients randomly received either IV ondansetron 100 μg/kg (group O), IV granisetron 40 μg/kg (group G), or normal saline (group P). Plasma levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were determined preoperatively and 24 hours postoperatively. The patients were observed for 24 hours for PONV and other possible AEs. Postoperative pain intensity was determined using a 10-cm visual analogue scale. Four-point satisfaction scores were determined at 24 hours.Results: Ninety patients (69 women, 21 men) participated in the study. Demographic characteristics and operative data (duration of surgery and anesthesia and amount of intraoperative fentanyl) were similar in the 3 groups. The only AE reported by patients during the 24-hour observation period was nonsevere headache. The number of patients experiencing headache was similar in group P, group O, and group G (10 [33%] patients, 6 [20%], and 10 [33%], respectively). No significant changes were found in presurgical and postsurgical plasma levels of ALT and AST in any group. The mean (SD) satisfaction scores in group O and group G (3.0 [0.4] and 3.0 [0.6], respectively) were significantly higher than those in group P (2.5 [0.5]; both, P < 0.01). Immediately after surgery (period 0), significantly more patients in the placebo group (21 [70%]) experienced PONV compared with those in the ondansetron group (9 [30%]; P < 0.05) and the granisetron group (7 [23%]; P < 0.01). During the 24-hour observation period, a significantly greater number of patients in group P (18 [60%]) required a single dose of a rescue antiemetic drug compared with those in groups O and G (9 [30%] and 6 [20%], respectively; both, P < 0.01).Conclusions: Patients administered ondansetron 100 μg/kg or granisetron 40 μg/kg 20 to 30 minutes before the end of LC had significantly higher PONV control during the 24-hour postoperative observation period than patients receiving placebo. However, there were no significant differences between the active treatment groups in the incidence of PONV, patient satisfaction, or AEs.     

Pediatric patients experiencing postoperative nausea and vomiting after burn reconstruction surgery: an analysis.

Nausea and vomiting after a surgical procedure has a significant impact on a patient's hospital course. A perceived increased incidence of postoperative nausea and vomiting (PONV) in pediatric patients undergoing reconstructive scalp surgery had been clinically observed. A chart review to determine if a relationship existed between the surgical procedure and the incidence of PONV was conducted by selecting patients who were 5 to 12 years old and whose surgery fell between April 1995 and August 1995. Thirty-eight patients were evaluated for 46 procedures; 8 patients were evaluated for both insertion and removal of scalp expanders. No differences were identified between groups for previous history of PONV, length of anesthesia, or position during surgery. Data from the retrospective review suggested that pediatric patients with reconstructive surgeries of the scalp experienced PONV at 100% (24 procedures), whereas only 45% (10 procedures) of patients whose surgeries did not involve the scalp experienced PONV. In addition, despite significant earlier return of bowel sounds, episodes of PONV and time to oral intake were also increased in the group of patients whose operations involved the scalp. On the basis of these findings, a prospective study has been initiated to determine if changes in the perioperative protocol will improve patient outcomes and reduce the incidence of PONV.     

Meclizine in combination with ondansetron for prevention of postoperative nausea and vomiting in a high-risk population

Postoperative nausea and vomiting (PONV) is prevalent in surgical patients with known risk factors: general anesthesia, female, nonsmoker, motion sickness history, and PONV history. Common treatment involves ondansetron; however, the effects are short-lived, and supplemental medication may be required. Meclizine, a long-acting drug with a low side-effect profile, may be ideal in combination with ondansetron for at-risk patients. We randomized 77 subjects scheduled for general anesthesia and screened for 4 of 5 PONV risk factors for experimental or control group assignment. Severity of PONV was measured using a 0 to 10 verbal numeric rating scale (VNRS). Other measured variables included time to onset and incidence of PONV and total antiemetic requirements. No significant differences in demographics (excluding weight), surgical or anesthesia time, analgesic requirements, or nausea incidence in the postanesthesia care unit (PACU) and same-day surgery unit were noted. The meclizine group had lower VNRS scores in the PACU at 15 (P = .013) and 45 (P = .006) minutes following rescue treatment. The incidence of nausea was lower in the meclizine vs. placebo group (10% vs. 29%) following discharge (P = .038). Prophylactic meclizine resulted in lower incidence and severity of PONV in a high-risk population, especially after rescue treatment.     

A systematic approach to the management of postoperative nausea and vomiting.

Postoperative nausea and vomiting (PONV), a common complication after anesthesia and surgery, often results in delayed discharge with the patient's unpleasant symptoms continuing at home. To effectively prevent and treat PONV, it is important to understand the factors implicated in PONV, the mechanisms of PONV, the pharmacology of the antiemetic agents, and the nonpharmacologic measures that have been shown to be effective. The cause of PONV is likely to be multifactorial, with important predictors being female gender, history of PONV, and history of motion sickness. The vomiting center can be triggered by activation of dopamine, serotonin (type 3), histamine (type 1), and muscarinic cholingergic receptors in the chemoreceptor trigger zone and the nucleus tractus solitarus, as well as acetylcholine receptors in the vestibular apparatus, vagal afferents from the periphery, and the endocrine environment. Antiemetic agents such as the serotonin antagonists (eg, ondansetron, dolasetron), droperidol, antihistamines (eg, diphenhydramine, dimenhydrinate), and promethazine can prevent and treat PONV effectively. Transdermal scopolamine and dexamethasone have a role in the prevention of PONV, particularly for certain high-risk patients. Nonpharmacologic measures and alternative treatments such as hydration, maintaining blood pressure, acupressure techniques, trancutaneous acupoint stimulation, and isopropyl alcohol must not be overlooked. Finally, an evidence-based algorithm for the prevention and treatment of PONV in adults is presented.     

Comparison of prophylactic anti-emetic effects of ondansetron and dexamethasone in women undergoing day-case gynaecological laparoscopic surgery

We aimed to determine the effect of ondansetron and dexamethasone on preventing post-operative nausea and vomiting (PONV). Sixty women undergoing laparoscopic gynaecological surgery were randomized to receive ondansetron 4 mg, dexamethasone 8 mg or saline. Drugs were administered 2 min before induction of anaesthesia, and anaesthesia and post-operative analgesic regimens were standardized. The incidence of PONV in the first 24 h after the operation was 35% in the ondansetron group, 55% in dexamethasone group and 85% in the control group. A significant difference between the groups was only seen in the first 3 h post-operatively. In this period, ondansetron was significantly more effective than dexamethasone and saline, but no differences were seen between dexamethasone and saline. In all treatment groups, post-operative visual analogue scale scores, sedation scores and usage of analgesics were similar. In conclusion, ondansetron, but not dexamethasone, prevented PONV in the first 3 h after gynaecological laparoscopic surgery.     

Effect of postoperative supplemental oxygen on nausea and vomiting after cesarean birth.

Postoperative nausea and vomiting (PONV) has a significant impact on patients and health care providers. Some nonpharmacologic methods may have an effect on PONV. Administration of supplemental oxygen (80%) during and for 2 hours after surgery has been shown to reduce the incidence of PONV from 44% to 22%. However, the effect of limiting supplemental oxygen to the immediate postoperative period on PONV is unknown. The purpose of this study was to test the efficacy of postoperative supplemental oxygen in reducing the incidence of PONV. Patients (n = 106) undergoing cesarean birth were given general anesthesia with 50% oxygen balanced nitrous oxide and in the postoperative period were randomly assigned to 2 groups. Patients in the experimental group received 8 L/min oxygen by a simple face mask for 6 hours. The control group received routine care of oxygen 5 L/min in the PACU and no supplemental oxygen on the ward. Trained nurses evaluated pulse oximetry and PONV after surgery. The incidence of PONV during the first 6 postoperative hours was 28.3% in the experimental group and 24.5% in the control group ( P = .659). There was no statistically significant difference between the 2 groups. In this study, postoperative supplemental oxygen 8 L/min did not prevent PONV in patients undergoing cesarean birth.     

Methylprednisolone reduces postoperative nausea in total knee and hip arthroplasty

What is known and objective: Total knee and hip joint replacement has a high risk of postoperative nausea and vomiting (PONV), and steroid cover is used for cases associated with autoimmune diseases. Our aim is to evaluate the antiemetic efficacy of methylprednisolone as steroid cover in patients undergoing the surgery. Methods: A prospective cohort study design was used. Sixty‐eight patients, aged between 20 and 80 years, were scheduled for a standardized general anaesthetic technique. Patients who were given methylprednisolone were assigned as the steroid cover group, and those who were not given methylprednisolone formed the non‐steroid cover group. PONV were assessment by direct questioning or spontaneous complaints by patients 1 week after surgery. Postoperative pain was evaluated using Visual Analog Scale (VAS) 1 and 3 days after surgery. Results and discussion: The incidence of nausea in the steroid cover group was significantly less than that in the non‐steroid cover group (adjusted odds ratio, 0·17, P = 0·021), but there was no significant difference in vomiting between the two groups. Postoperative pain VAS score was not significantly different between groups. What is new and conclusion: In total knee and hip arthroplasty, methylprednisolone is effective in preventing postoperative nausea; however, higher doses of methylprednisolone may be needed to prevent vomiting.     

Intravenous ondansetron for the control of opioid-induced nausea and vomiting. International S3AA3013 Study Group.

This randomized, double-masked, placebo-controlled, multicenter trial was conducted in 9 countries to assess the safety and efficacy of 2 doses of intravenous ondansetron (8 and 16 mg) for the control of opioid-induced nausea and vomiting. A total of 2574 nonsurgical patients who presented with pain requiring treatment with an opioid analgesic agent participated in this trial. The most common presenting painful condition was back or neck pain, reported by approximately one third of patients. A total of 520 patients (317 females, 203 males) developed nausea or vomiting after opioid administration and were randomly assigned to receive a single dose of 1 of 3 study treatments: placebo (n = 94), ondansetron 8 mg (n = 215), or ondansetron 16 mg (n = 211). Ondansetron 8 and 16 mg led to complete control of emesis in 134 of 215 patients (62.3%) and 145 of 211 patients (68.7%), respectively. Results with both doses were significantly better than those seen with placebo (43 of 94 patients [45.7%]). Complete control of nausea was achieved in 6.8% of placebo patients, 14.8% of ondansetron 8-mg-treated patients, and 19.4% of ondansetron 16-mg treated patients; only ondansetron 16 mg was significantly better than placebo (P = 0.007). Significantly more patients who received ondansetron 8 mg than patients who received placebo were satisfied/very satisfied with their antiemetic treatment, as assessed by 4 patient-satisfaction questions. Significantly more patients who received ondansetron 16 mg compared with placebo were satisfied/very satisfied on 2 of 4 satisfaction questions. In conclusion, based on the observed incidence of opioid-induced nausea and vomiting in this study, it may be more appropriate to treat symptoms on occurrence rather than administering antiemetic agents prophylactically. The results of this study demonstrate that intravenous ondansetron in doses of 8 or 16 mg is an effective antiemetic agent for the control of opioid-induced nausea and vomiting in nonsurgical patients requiring opioid analgesia for pain.     

A comparative analysis of isopropyl alcohol and ondansetron in the treatment of postoperative nausea and vomiting from the hospital setting to the home

We compared the efficacy of inhaled isopropyl alcohol (IPA) with ondansetron for the control of postoperative nausea and vomiting (PONV) during a 24-hour period in 100 ASA class I-III women undergoing laparoscopic surgery. Nausea was measured postoperatively using a 0 to 10 verbal numeric rating scale (VNRS). The control group received ondansetron, 4 mg intravenously, and the experimental group inhaled IPA vapors. Breakthrough PONV was treated with 25-mg promethazine suppositories. Demographic and anesthesia characteristics were similar between groups. There was a significant difference between groups in mean +/- SD time to alleviation of PONV symptoms: for a 50% reduction in VNRS scores, 15.00 +/- 10.6 vs. 33.88 +/- 23.2 minutes was required in the experimental vs. the control group (P = .001). A total of 21 subjects (10 control; 11 experimental) reported PONV symptoms following discharge to home. The IPA treatment was successful in alleviating PONV symptoms in the home in 91% of the experimental group. We determined that using IPA after discharge from the postanesthesia care unit is a valuable method to control PONV in the hospital and at home. The results of this study suggest that IPA is much faster than ondansetron for 50% relief of nausea.     

A randomized double blind study to evaluate efficacy of palonosetron with dexamethasone versus palonosetron alone for prevention of postoperative and postdischarge nausea and vomiting in subjects undergoing laparoscopic surgeries with high emetogenic risk

Postoperative nausea and vomiting (PONV) and postdischarge nausea and vomiting (PDNV) are common occurrences (50%-80%) after laparoscopic surgery. Palonosetron (Pal), the newest 5-HT3 antagonist, is an effective antiemetic that has advantages in treating PDNV due to its prolonged duration of action. We hypothesized that a combination of Pal and dexamethazone (Dex) could further improve the efficacy of the treatment in comparison to Pal alone in patients at high risk for PONV. Patients scheduled to undergo laparoscopic surgeries under general anesthesia were randomized to receive 8-mg dexamethasone + 0.075-mg palonosetron (Pal + Dex) or an equivalent volume of saline + 0.075 mg palonosetron (Pal). Data was collected at defined postoperative times (2, 6, 12, 24, and 72 hours). All patients also completed an 18-question QOL-Functional Living Index-Emesis instrument at 96 hours. We enrolled 118 patients, ASA 1-2, with at least 3 PONV risk factors, who were undergoing outpatient surgery. Both groups had a low incidence of vomiting in the PACU (Pal + Dex, 1.7%; Pal, 6.8%) and at 72 hours (0.0% both groups). Complete response (no vomiting, no rescue medication) was not different between treatment groups for any time intervals. Cumulative success rates over the entire 72 hours were 60.4% (Pal + Dex) versus 60.0% (Pal). The Pal + Dex group showed a trend toward greater satisfaction on the QOL- Functional Living Index-Emesis scores with the greatest differences in the "nausea domain". The combination therapy of palonosetron + dexamethasone did not reduce the incidence of PONV or PDNV when compared with palonosetron alone. There was no change in comparative efficacy over 72 hours, most likely due to the low incidence of PDNV in both groups.     

Efficacy of prophylactic ondansetron in a patient-controlled analgesia environment

We conducted a prospective, randomized, double-blind, placebo-controlled trial to examine the efficacy of prophylactic ondansetron on post-operative nausea and vomiting (PONV) during opioid patient-controlled analgesia (PCA). In total, 374 patients using opioid PCA, but otherwise considered to be low risk for PONV, were randomly allocated to ondansetron (4 mg given intravenously and 16 mg added into the PCA pump) or saline (control group). PONV was evaluated in terms of nausea graded on a visual analogue scale, and the number of patients who experienced emetic episodes or needed rescue anti-emetics in the 48-h post-operative period. Patient satisfaction for PCA was scored at the end of the evaluation period. The only difference between the two groups was the higher number of headaches in the ondansetron group. In patients using opioid PCA, but with no other high risk factors for PONV, prophylactic ondansetron does not have any clinical benefit.     

Antagonistic Effects of Ondansetron and Tramadol? A Randomized Placebo and Active Drug Controlled Study

Opposing effects of ondansetron and tramadol on the serotonin pathway have been suggested which possibly increase tramadol consumption and emesis when co-administered. In a randomized, double-blinded study, 179 patients received intravenous ondansetron, metoclopramide, or placebo for emesis prophylaxis. Analgesic regimen consisted of tramadol intraoperative loading and subsequent patient-controlled analgesia. Tramadol consumption and response to antiemetic treatment were compared. Additionally, plasma concentrations of ondansetron and (+)O-demethyltramadol and CYP2D6 genetic variants were analyzed as possible confounders influencing analgesic and antiemetic efficacy. Tramadol consumption did not differ between the groups. Response rate to antiemetic prophylaxis was superior in patients receiving ondansetron (85.0%) compared with placebo (66.7%, P = .046), with no difference to metoclopramide (69.5%). Less vomiting was reported in the immediate postoperative hours in the verum groups (ondansetron 5.0%, metoclopramide 5.1%) compared with placebo (18.6%; P = .01). Whereas plasma concentrations of (+)O-demethyltramadol were significantly correlated to CYP2D6 genotype, no influence was detected for ondansetron. Co-administration of ondansetron neither increased tramadol consumption nor frequency of PONV in this postoperative setting.     

Transcutaneous electrical acupoint stimulation versus ondansetron in the prevention of postoperative vomiting following pediatric tonsillectomy

OBJECTIVES: Postoperative retching and vomiting is an important cause of morbidity that may lead to patient discomfort, distress, and complications. Stimulation of acupuncture points has been shown to be effective in the prevention as well as treatment of PONV. The current treatments of choice are the 5-hydroxytryptamine type 3-antagonists, such as ondansetron. We aimed to evaluate the efficacy and side-effects of either transcutaneous electrical acupoint stimulation (TEAS) or Ondansetron compared to a control group receiving no treatment in the prevention of postoperative retching and vomiting. SUBJECT AND DESIGN: This randomized, controlled, prospective study was carried out in a group of 90 children (in three equal randomly assigned groups), aged between 4 and 12 who underwent tonsillectomy under general anesthesia. In the first group, electrical stimulation via surface electrodes on acupoints Neiguan and Shangwan was performed (20 Hz, 5 minutes). The second group received a single dose of Ondansetron (0.15 mg . kg(-1)). No treatment was given to the control group. OUTCOME MEASURES: The frequency of retching and vomiting attacks and side-effects were noted on the day of surgery in the postanesthesia care unit and the day surgery care unit, on the day of surgery after discharge, and on the first day after surgery. A satisfaction scale was completed by each family. RESULTS: There was a significant difference between the treatment groups and the control group in the incidence of emetic episodes occurring in the day surgery care unit and on the day after discharge (p < 0.001). In the ondansetron group, side-effects were seen in more patients than in the other groups (p < 0.001). The satisfaction scores of the parents were greater in the treatment groups than in the control group (p < 0.05). CONCLUSION: Application of TEAS on sedated children is an easy, painless, reliable and effective method for the prophylaxis of postoperative retching and vomiting in pediatric tonsillectomy.     

Prevention of vomiting after general anesthesia for pediatric ophthalmic surgery.

We evaluated the effectiveness of a multifaceted general anesthesia protocol designed to minimize postoperative vomiting after pediatric eye surgery. A convenience sample of 150 consecutive children, aged 2 weeks to 18 years, who received general anesthesia for pediatric ophthalmic surgery was studied. General anesthesia was administered with induction by mask for 82.7% of the children and intravenously using propofol in 17.3% of the children. Anesthesia was maintained using halothane or isoflurane, oxygen, and air mixture for all patients. Morphine sulfate was used for additional pain relief, up to 0.1 mg/kg. Gastric aspiration was performed after intubation for each child. Metoclopramide, 0.15 mg/kg, and 0.1 mg/kg of ondansetron were administered before the end of each operation. Postoperatively, patients were monitored for vomiting for 24 hours. Postoperative vomiting occurred in 11 (7.3%) of 150 cases. Acute elevation of intraocular pressure was found in 5 of the 11 children who vomited. This vomiting was unresponsive to intravenous rescue ondansetron, but responded to lowering the intraocular pressure. The incidence of postoperative vomiting after general anesthesia for pediatric eye surgery can be substantially decreased by adopting a protocol designed to lessen the emetic effects of general anesthesia. Limited use of nitrous oxide for mask induction only, gastric emptying, and administration of metoclopramide and ondansetron intravenously in combination proved effective in reducing the incidence of postoperative vomiting.     

Efficiency of using ondansetron in the surgical treatment of post-burn cicatricial deformity in children with a history of postoperative nausea and vomiting

The efficiency of using various formulations of the antiemetic ondansetron to prevent postoperative nausea and vomiting (PONV) in the surgical treatment of postburn scars and deformities in children with a family history of PONV was compared. The patients were randomized into 4 representative groups. Preoperative administration of ondansetron (zofran) as lingual tablets was shown to be most effective. When the drug was used as syrup, PONV developed 2 times more frequently (PONV in 20% of the patients and 3 times more commonly when the drug was intravenously injected as jets during induction to anesthesia (PONV in 30% of the patients. When antiemetics were not given (a control group), the incidence was 7.5 times greater (75% of cases).