Anti-emetic efficacy of prophylactic granisetron compared with perphenazine for the prevention of post-operative vomiting in children.

We have compared the efficacy of granisetron with perphenazine in the prevention of vomiting after tonsillectomy with or without adenoidectomy in children. In a prospective, randomized, double-blind study, 90 paediatric patients, ASA I, aged 4-10 years, received granisetron 40 mg kg-1 or perphenazine 70 mg kg-1 (n = 45 each) intravenously immediately after an inhalation induction of anaesthesia. A standard general anaesthetic technique was employed throughout. A complete response, defined as no emesis with no need for another rescue antiemetic, during the first 3 h (0-3 h) after anesthesia was 87% with granisetron and 78% with perphenazine (P = 0.204). The corresponding incidence during the next 21 h (3-24 h) after anaesthesia was 87% and 62% (P = 0.007). No clinically serious adverse events were observed in any of the groups. We conclude that granisetron is a better anti-emetic than perphenazine for the long-term prevention of post-operative vomiting in children undergoing general anaesthesia for tonsillectomy.     

Effects of anticholinergics on postoperative vomiting, recovery, and hospital stay in children undergoing tonsillectomy with or without adenoidectomy

BACKGROUND: Nausea and vomiting are the most frequent problems after minor ambulatory surgical procedures. The agents used to induce and maintain anesthesia may modify the incidence of emesis. When neuromuscular blockade is antagonized with anticholinesterases, atropine or glycopyrrolate is used commonly to prevent bradycardia and excessive oral secretions. This study was designed to evaluate the effect of atropine and glycopyrrolate on postoperative vomiting in children. METHODS: Ninety-three patients undergoing tonsillectomy with or without adenoidectomy were studied. After inhalation induction of anesthesia with nitrous oxide, oxygen, and halothane, anesthesia was maintained with a nitrous oxide-oxygen mixture, halothane, morphine, and atracurium. Patients were randomized to receive, in a double-blinded manner, either 15 microg/kg atropine or 10 microg/kg glycopyrrolate with 60 microg/kg neostigmine to reverse neuromuscular blockade. Patient recovery, the incidence of postoperative emesis, antiemetic therapy, and the duration of postoperative hospital stay were assessed. RESULTS: There were no significant differences in age, gender, weight, or discharge time from the postanesthesia care unit or the hospital between the groups. Twenty-four hours after operation, the incidence of vomiting in the atropine group (56%) was significantly less than in the glycopyrrolate group (81%; P<0.05). There was no significant difference between the atropine and glycopyrrolate groups in the number of patients who required antiemetics or additional analgesics. CONCLUSIONS: In children undergoing tonsillectomy with or without adenoidectomy, reversal of neuromuscular blockade with atropine and neostigmine is associated with a lesser incidence of postoperative emesis compared with glycopyrrolate and neostigmine.     

Preoperative oral granisetron for the prevention of vomiting following paediatric surgery

BACKGROUND: We evaluated the efficacy of granisetron, 5-hydroxytryptamine type 3 receptor antagonist, given orally, preoperatively, for the prevention of postoperative vomiting in children undergoing general anaesthesia for surgery (inguinal hernia, phimosis-circumcision). METHODS: In a randomized, double-blinded manner, 100 children, ASA physical status I, aged 4-11 years, received orally placebo or granisetron at three different doses (20 microg x kg(-1), 40 microg x kg(-1), 80 microg x kg(-1)) 60 min before surgery (n=25 of each). The same standard general anaesthetic technique was used. RESULTS: The percentage of patients being emesis-free during 0-6 h after anaesthesia was 56% with placebo, 64% with graniseron 20 microg x kg(-1) (P=0.773), 88% with granisetron 40 microg x kg(-1) (P=0.027) and 92% with granisetron 80 microg x kg(-1) (P=0.01); the corresponding rate during 6-24 h after anaesthesia was 60%, 68% (P=0.768), 92% (P=0.02) and 92% (P=0.02) (P-values versus placebo). No clinically serious adverse events were observed in any of the groups. CONCLUSIONS: In summary, preoperative oral granisetron 40 microg x kg(-1) is effective for the prevention of vomiting following paediatric surgery (inguinal hernia, phimosis-circumcision). Increasing the doses to 80 microg x kg(-1) provides no demonstrable additional benefit.     

Oral granisetron prevents postoperative vomiting in children

We have studied the efficacy of granisetron, a selective 5- hydroxytryptamine type 3 receptor antagonist, administered orally for the prevention of postoperative vomiting after tonsillectomy in children. In a randomized, double-blind, placebo-controlled study, 160 paediatric patients, ASA 1, aged 4-10 yr, received placebo or granisetron (20, 40 or 80 micrograms kg-1) (n = 40 each) orally, 1 h before surgery. A standard general anaesthetic technique was used throughout. A complete response, defined as no emesis and no need for another rescue antiemetic during the first 24 h after anaesthesia, occurred in 40%, 48%, 85% and 90% of patients who had received placebo, or granisetron 20, 40 or 80 micrograms kg-1, respectively (P < 0.05; overall Fisher's exact probability test). There were no clinically important adverse events. We conclude that preoperative oral granisetron, in doses more than 40 micrograms kg-1, was effective for the prevention of postoperative vomiting in children.      

Comparison of granisetron, droperidol, and metoclopramide for prevention of postoperative vomiting in children with a history of motion sickness undergoing tonsillectomy

BACKGROUND/PURPOSE: A history of motion sickness is one of the patient-related factors associated with postoperative vomiting (POV). This study was undertaken to compare the efficacy of granisetron, droperidol, and metoclopramide for the prevention of POV after tonsillectomy in children with a history of motion sickness. METHODS: In a prospective, randomized, double-blinded trial, 90 pediatric patients, aged 4 to 10 years, received granisetron, 40 microg/kg; droperidol, 50 microg/kg; or metoclopramide, 0.25 mg/kg (n = 30 of each) intravenously after an inhalation induction of anesthesia. Emetic episodes and safety assessments were performed during the first 24 hours after anesthesia. RESULTS: Twenty-two of 30 patients (73%) who had received granisetron were emesis free during the first 24 hours after surgery as compared with 7 of 30 (23%) who had received droperidol (P <.05) or 6 of 30 (20%) who had received metoclopramide (P <.05). No clinically serious adverse events were observed in any of the groups. CONCLUSION: Prophylactic therapy with granisetron is superior to droperidol or metoclopramide for the prevention of POV after tonsillectomy in children with a history of motion sickness.     

RETRACTED ARTICLE: Granisetron reduces vomiting after strabismus surgery and tonsillectomy in children

Purpose

To evaluate the antiemetic efficacy of granisetron, a selective 5-hydroxytryptamine type 3 receptor antagonist, on postoperative vomiting in children undergoing general anaesthesia for strabismus repair and tonsillectomy with or without adenoidectomy.

Methods

In a randomized, placebo-controlled, double-blind study, fifty patients, 4–10 yr of age, were given a single dose of either placebo (saline, n = 25) or granisetron (40 μg · kg^?1, n = 25) iv over 2–5 min after the induction of anaesthesia and prior to the surgical procedure. Postoperatively, during the first 24 hr after anaesthesia, the frequencies of retching and vomiting were recorded.

Results

There were no differences between the two groups with regard to patient characteristics, surgical procedures and anaesthetic or postoperative management. The incidence of retching was 36% and 12% after administration of placebo or granisetron, respectively (P < 0.05); the corresponding frequencies of vomiting were 32% and 8% (P < 0.05). Four children who had received placebo required another rescue antiemetic drug, whereas none who had received granisetron needed this agent.

Conclusion

Granisetron is effective in the prevention of retching and vomiting after strabismus repair and tonsillectomy in paediatric patients.     

Retracted: Comparison of granisetron and droperidol in the prevention of vomiting after strabismus surgery or tonsillectomy in children

This prospective, randomized, double-blinded study evaluated the antiemetic efficacy of granisetron and droperidol in 80 ASA physical status I children, aged 4–10 years, undergoing strabismus surgery or tonsillectomy with or without adenoidectomy. After anaesthetic induction, the patients received either granisetron (40 μg·kg^?1, n=40) or droperidol (50 μg·kg^?1, n=40) intravenously. The incidence of vomiting during the first 24 h after anaesthesia was 15% and 38% after administering granisetron and droperidol, respectively(r)( P=0.02). The requirement for rescue antiemetic therapy for the treatment of two or more episodes of vomiting was 0% with granisetron and 18% with droperidol ( P=0.001). In conclusion, granisetron was superior to droperidol in reducing the incidence and frequency of postoperative vomiting in paediatric patients.     

Comparison of ramosetron and granisetron for preventing postoperative nausea and vomiting after gynecologic surgery.

In a prospective, randomized, double-blinded study, we evaluated the efficacy of granisetron and ramosetron for preventing postoperative nausea and vomiting (PONV) in major gynecologic surgery. One hundred twenty patients, ASA physical status I or II, aged 23-65 yr, received i.v. granisetron 2.5 mg or ramosetron 0.3 mg (n = 60 each) at the end of surgery. A standard general anesthetic technique and postoperative analgesia were used. The incidence of a complete response, defined as no PONV and no need for another rescue medication, 0-3 h after anesthesia was 87% with granisetron and 90% with ramosetron; the corresponding incidence 3-24 h after anesthesia was 85% and 90%; the corresponding incidence 24-48 h after anesthesia was 70% and 92% (P < 0.05). No clinically serious adverse events due to the drugs were observed in any of the groups. In conclusion, prophylactic therapy with ramosetron is more effective than granisetron for the longterm prevention of PONV after major gynecologic surgery. Implications: We compared the efficacy of granisetron and ramosetron for preventing postoperative nausea and vomiting in major gynecologic surgery. Prophylactic therapy with ramosetron was more effective than granisetron for preventing postoperative nausea and vomiting 24-48 h after anesthesia.     

RETRACTED ARTICLE: Antiemetic efficacy of granisetron and metoclopramide in children undergoing ophthalmic or ENT surgery

Purpose

The purpose of this study was to compare the effectiveness of granisetron, metoclopramide and placebo in reducing the frequencies of retching and vomiting in children who had undergone strabismus repair and tonsillectomy with or without adenoidectomy.

Methods

In a randomized, double-blind study, 70 healthy subjects, 4–10 yr of age, were given a single dose of either placebo (saline, n = 24), metoclopramide 0.25 mg · kg^?1 (n = 23) granisetron 40 μg · kg^?1 (n = 23) iv over two to five minutes after the induction of anaesthesia. All subjects received inhalation anaesthesia with sevoflurane and nitrous oxide in oxygen. Rescue antiemetics were administered if two or more episodes of vomiting occurred. Acetaminophen pr or pentazocine iv was given as needed for postoperative pain. All subjects remained in hospital for two days. During the first three and the next 21 hr after anaesthesia, the frequencies of retching and vomiting were recorded by nursing staff.

Results

There was no difference among groups with regard to demographic characteristics, surgical procedures, anaesthetics administered, postoperative managements, or adverse effects. During 0–3 hr after anaesthesia, the frequencies of retching and vomiting were: placebo 62%, metoclopramide 22% and granisetron 13% (P < 0.05). The corresponding frequencies during 3–24 hr after anaesthesia were: placebo 50%, metoclopramide 39% and granisetron 13% (P < 0.05). Four children who had received placebo and three who had received metoclopramide required another rescue antiemetic.

Conclusion

Granisetron 40 μg · kg^?1 is more effective than either metoclopramide or placebo in reducing the frequencies of postoperative retching and vomiting during the first 24 hr after anaesthesia in children who have undergone strabismus surgery and tonsillectomy with or without adenoidectomy.     

RETRACTED ARTICLE: Granisetron and dexamethasone provide more improved prevention of postoperative emesis than granisetron alone in children

Purpose

Dexamethasone decreases chemotherapy-induced emesis when added to antiemetic regimens. This study was designed to compare the effectiveness of granisetron and dexamethasone with granisetron alone in the prevention of postoperative vomiting after strabismus repair, tonsillectomy with or without adenoidectomy in children.

Methods

In a randomized, double-blind study, 60 healthy children, 4–10 yr of age, received either granisetron 40 μg · kg^?1 and saline (Group S) or granisetron 40 μg · kg^?1 and dexamethasone 4 mg (Group D) iv immediately after the induction of anaesthesia. All subjects received anaesthetics consisting of sevoflurane and nitrous oxide in oxygen. Postoperative pain was treated with acetaminophen pr or pentazocine iv. Postoperatively, during the first 24 hr after anaesthesia, the frequencies of retching and vomiting, and the incidence of adverse events were recorded by nursing staff.

Results

There were no differences between the treatment groups with regard to demographics, surgical procedure, anaesthetic administered or analgesics used for postoperative pain. The frequency of the symptoms was 27% and 7% in Groups S and D, respectively (P < 0.05). The incidence of adverse events was comparable in the two groups.

Conclusion

The prophylactic administration of granisetron and dexamethasone was more effective than granisetron alone in the prevention of postoperative vomiting in paediatric subjects undergoing strabismus repair, tonsillectomy and adenoidectomy.     

Prevention of postoperative vomiting with granisetron in paediatric patients with and without a history of motion sickness

A history of motion sickness is one of the patient-related factors associated with postoperative emesis. This prospective, randomized, double-blind, placebo-controlled study was undertaken to assess the efficacy of granisetron, a selective 5-hydroxytryptamine type 3 receptor antagonist, for preventing postoperative vomiting after tonsillectomy in 120 children with (n = 60) and without (n = 60) a history of motion sickness. Patients received a single dose of granisetron (40 micrograms.kg-1) or placebo (saline) (n = 30 of each) intravenously after an inhalation induction of anaesthesia. A complete response, defined as no vomiting, no retching and no need for another rescue medication, during the first 24 h after anaesthesia was 77% and 13% in patients with a history of motion sickness who had received granisetron or placebo, respectively; the corresponding incidence was 83% and 40% in those without it (P < 0.05; chi 2 test with Yates' continuity correction). No clinically serious adverse effects due to the study drug were observed in any of the groups. In conclusion, prophylactic antiemetic therapy with granisetron is effective for preventing postoperative emesis in children with a history of motion sickness as well as in those without it.     

RETRACTED ARTICLE: Effective dose of granisetron for preventing postoperative emesis in children

Purpose

This study was to identify the minimum effective dose of granisetron, a selective 5-hydroxytryptamine type 3 receptor antagonist, to prevent postoperative vomiting in children who have undergone strabismus repair, tonsillectomy or tonsillectomy with adenoidectomy.

Methods

In a randomized, double-blind fashion, 80 healthy children aged 4–10 yr were assigned to receive either placebo (saline) or granisetron in a dose of 20, 40 or 80 μg· kg^?1 iv immediately following the induction of anaesthesia. All subjects received a standardized anaesthetic, which consisted of sevoflurane in nitrous oxide and oxygen. Rescue antiemetics were administered if two or more episodes of vomiting occurred. Postoperative pain was treated with acetaminophene pr or pentazocine iv. During the first 24 hr after anaesthesia, the frequencies of retching and vomiting were recorded in a standardized fashion by nursing staff while subjects were in a hospital.

Results

There were no differences among four treatment groups with regard to subject characteristics, surgical procedures, anaesthetic and postoperative management or adverse effects. The frequencies of these symptoms were as follows: 65%, 60%, 20% and 15% after administration of placebo, granisetron 20, 40 or 80 μg· kg^?1. Three children who had received either placebo or granisetron 20 μg · kg^?1 required another rescue antiemetic drug, whereas none who had received granisetron 40 or 80 μg · kg^?1 needed rescue drugs.

Conclusion

Granisetron 40 μg · kg^?1 is an effective antiemetic for preventing retching and vomiting following strabismus repair and tonsillectomy in children. Increasing the dose to 80 μg ·kg ^?1 provided no demonstrable benefit in reducing postoperative emesis.     

The efficacy of oral clonidine premedication in the prevention of postoperative vomiting in children following strabismus surgery

We evaluated the efficacy of clonidine given orally preoperatively for preventing postoperative vomiting (POV) in children undergoing propofol-nitrous oxide anaesthesia for strabismus surgery. Sixty children, ASA physical status I, aged 2-12 years, received diazepam, 0.4 mg x kg(-1) or clonidine, 4 microg x kg(-1) (n=30 each) orally, in a randomized double-blind manner. These drugs were given 105 min before an inhalational induction of anaesthesia. A complete response, defined as no POV and no need for rescue antiemetic medication, during 0-24 h after anaesthesia was 67% with diazepam and 93% with clonidine, respectively (P=0.024). No clinically adverse event was observed in any of the groups. In summary, pretreatment with oral clonidine enhances the antiemetic efficacy of propofol for the prevention of POV after paediatric strabismus surgery.     

A comparison of oral clonidine and oral midazolam as preanesthetic medications in the pediatric tonsillectomy patient

We compared the effects of oral clonidine (4 microg/kg) and midazolam (0.5 mg/kg) on the preanesthetic sedation and postoperative recovery profile in children during tonsillectomy with or without adenoidectomy. In a double-blinded, double-dummy study design, 134 ASA physical status I-II children aged 4-12 yr were randomized to receive a combination of either clonidine and placebo (Group A), or placebo and midazolam (Group B) at 60-90 min and 30 min, respectively, before the induction of anesthesia. Children in the clonidine group exhibited more intense anxiety on separation and during induction of anesthesia via a mask as measured by the modified Yale Preoperative Anxiety Scores. They also had significantly lower mean intraoperative arterial blood pressures, shorter surgery, anesthesia, and emergence times, and a decreased need for supplemental oxygen during recovery compared with the midazolam group. However, the clonidine group had larger postoperative opioid requirements, maximum excitement and pain scores based on the Children's Hospital of Eastern Ontario scale in the Phase 1 postanesthetic care unit. There were no differences between the two groups in the times to discharge readiness, postoperative emesis, unanticipated hospital admission rates, postdischarge maximum pain scores, and 24 h analgesic requirements. The percentage of parents who were completely satisfied with the child's preoperative experience was significantly higher in the midazolam group. There were no differences in parental satisfaction with the recovery period. We conclude that under the conditions of this study, oral midazolam is superior to oral clonidine as a preanesthetic medication in this patient population. Implications: We compared preanesthetic sedation and postoperative recovery after oral clonidine (4 microg/kg) and midazolam (0.5 mg/kg) in children during tonsillectomy. The clonidine group had greater preoperative anxiety and shorter surgery and anesthesia times, but required more postoperative analgesia. Delayed recovery and discharge times did not differ. Midazolam was superior to clonidine as oral preanesthetic medication for these patients.     

Preemptive antiemesis in patients undergoing modified radical mastectomy: oral granisetron versus oral ondansetron in a double-blind, randomized, controlled study

STUDY OBJECTIVE: To assess the efficacy of oral granisetron versus oral ondansetron for preemptive antiemesis in women undergoing modified radical mastectomy. DESIGN: Randomized, double-blind, controlled study. SETTING: Metropolitan hospital. PATIENTS: Ninety ASA physical status I and II hospitalized female patients, aged 18 to 65 y, scheduled for modified radical mastectomies. INTERVENTIONS: Patients were assigned to receive orally placebo, granisetron 2 mg, or ondansetron 4 mg (n = 30 in each group) 1 h before induction of anesthesia. A standard general anesthetic technique and postoperative analgesia were used. MEASUREMENTS: Postoperative nausea and vomiting and safety assessments were performed continuously 0 to 2, 2 to 6, 6 to 12, and 12 to 24 h after anesthesia. MAIN RESULTS: A complete response during 0 to 2 h after anesthesia was found in 43%, 63%, and 90% of patients who had received placebo, granisetron, or ondansetron, respectively; corresponding percentages of patients requiring rescue antiemetics were 40%, 17%, and 7%. Frequency of nausea and vomiting was low (less than 23%) after 2 h in the three groups. Observations of postoperative nausea and vomiting score and need for antiemetics at other time intervals (2 to 6, 6 to 12, and 12 to 24 h) were not significantly different among the three groups. CONCLUSION: Oral ondansetron 4 mg provided better preemptive antiemesis than oral granisetron 2 mg in the 2 h after modified radical mastectomy during general anesthesia.     

Combination of granisetron and droperidol for the prevention of vomiting after paediatric strabismus surgery.

This study was undertaken to compare the efficacy of granisetron plus droperidol with each antiemetic alone for the prevention of vomiting after paediatric strabismus surgery. In a prospective, randomized, double-blinded trial, 120 ASA physical status I children, aged 4-10 years, received granisetron 40 microg.kg- 1, droperidol 50 microg.kg- 1, granisetron 40 microg.kg- 1 plus droperidol 50 microg.kg- 1 (n=40 of each) intravenously after an inhalation induction of anaesthesia. A complete response, defined as no vomiting, no retching and no need for another rescue antiemetic medication, during 0-3 h after anaesthesia was 80% with granisetron, 45% with droperidol and 98% with granisetron plus droperidol, respectively; the corresponding incidence during 3-24 h after anaesthesia was 78%, 38% and 98% (P< 0.05; overall chi-squared test with Yates continuity correction). No clinically important adverse events were observed in any of the groups. In conclusion, a combination of granisetron and droperidol was more effective than granisetron or droperidol as a sole antiemetic for the prevention of postoperative vomiting in children undergoing strabismus repair.     

Superior anti-emetic efficacy of granisetron-dexamethasone combination in children undergoing middle ear surgery

AIM: To compare the effectiveness of granisetron and a granisetron-dexamethasone combination for the prevention of post-operative vomiting in children undergoing middle ear surgery. METHODS: Ninety ASA physical status I or II children, aged 3-12 years, were randomly assigned to three groups of 30 each to receive a single dose of placebo (normal saline), granisetron 40 microg/kg or a combination of granisetron 40 microg/kg and dexamethasone 150 microg/kg intravenously after the induction of anaesthesia. Peri-operative anaesthetic care was standardized in all children. Post-operatively, during the first 24 h after anaesthesia, the frequencies of retching and vomiting and the incidence of adverse events were recorded. Rescue anti-emetic was administered if two or more episodes of emesis occurred. Post-operative pain was treated with morphine intravenously, followed by acetaminophen orally. RESULTS: There were no differences between the treatment groups with regard to demographic data. A complete response (no retching/vomiting and no need for rescue anti-emetic) was achieved in 50%, 80% and 96.67% of children who received saline, granisetron and granisetron-dexamethasone, respectively (P < 0.05). Six children who received placebo and one who received granisetron alone required another rescue anti-emetic. The incidence of adverse events was comparable in the three groups. CONCLUSION: The prophylactic granisetron-dexamethasone combination was more effective than granisetron alone in the prevention of post-operative emesis during the first 24 h after anaesthesia in children undergoing middle ear surgery.     

Comparison of oral dolasetron and ondansetron in the prophylaxis of postoperative nausea and vomiting in children

BACKGROUND AND OBJECTIVE: In a randomized, placebo-controlled, double-blind trial, we compared the efficacy of oral dolasetron and ondansetron in preventing postoperative nausea and vomiting in children after various surgical operations. METHODS: Children were assigned randomly to one of three groups (each contained 50 children) to receive dolasetron 1.8 mg kg(-1) or ondansetron 0.15 mg kg(-1) orally, or a placebo. All children received methylene blue capsules (10 mg) orally as an indicator before the induction of anaesthesia. Postoperatively, contamination of the mouth and the endotracheal tube by methylene blue was recorded, and postoperative nausea and vomiting was recorded for 0-1, 1-24 and 0-24 h. Metoclopramide (0.1 mg kg(-1)) intravenously was used as the rescue antiemetic. RESULTS: In the 0-1 h period after operation, there were no differences between the groups. In the 1-24 h period, dolasetron was significantly better than placebo (nausea 8 versus 24%; vomiting 4 versus 20%; total nausea and vomiting scores 16 versus 48%). Over the 0-24 h period, both dolasetron and ondansetron were significantly better than placebo (nausea 16 versus 26 versus 40%), vomiting (8 versus 16 versus 30%), and total nausea and vomiting scores (32 versus 48 versus 78%). There were no significant differences between dolasetron and ondansetron. There was no important methylene blue contamination, and little use of rescue metoclopramide. There were no important adverse events. CONCLUSIONS: Prophylactic oral dolasetron and ondansetron were effective in reducing postoperative nausea and vomiting in children.     

Prophylaxis for vomiting by children after tonsillectomy: ondansetron compared with perphenazine

We have compared the effects of ondansetron and perphenazine on vomiting after tonsillectomy in 216 healthy children, aged 2-12 yr. The study was randomized, stratified, blocked and double blind. Anaesthesia was induced with propofol i.v. or by inhalation of halothane and nitrous oxide. Ondansetron 150 micrograms kg-1 or perphenazine 70 micrograms kg-1 was administered i.v. after induction of anaesthesia in a double-blind manner. Perioperative management of emesis, pain, fluids and patients discharge were standardized. Ondansetron and perphenazine had similar effects on postoperative vomiting (44% vs 41%; ondansetron vs perphenazine P = 0.77). By logistic regression analysis, the only significant predictor of postoperative vomiting was sex, that is males had a greater incidence of vomiting (49% vs 35%; P = 0.016). In- hospital vomiting was associated with a prolongation of stay in the day- care surgical unit of 7 min per episode of vomiting (P = 0.015). We conclude that ondansetron and perphenazine had similar effects on vomiting in children after tonsillectomy in a day-case setting.      

Metoclopramide reduces the incidence of vomiting after tonsillectomy in children.

The efficacy of intravenous metoclopramide in controlling vomiting in children after tonsillectomy was determined in a prospective randomized, double-blind investigation. One hundred two unpremedicated, ASA physical status I or II children between the ages of 1 and 15 yr who were undergoing surgical removal of the tonsils, with or without adenoidectomy, were studied. Anesthesia was induced either with halothane, nitrous oxide, and oxygen by mask or by intravenous thiopental and was maintained with halothane, nitrous oxide, oxygen, and intravenous morphine (0.1 mg/kg). Each child randomly received either 0.15 mg/kg of metoclopramide or saline solution placebo intravenously after transfer to the postanesthesia care unit. All episodes of vomiting were recorded for 24 h after completion of surgery. The incidence of vomiting in the saline solution group was 70%, compared with 47% in the metoclopramide group (P = 0.026). The authors conclude that the administration of intravenous metoclopramide in a dose of 0.15 mg/kg on arrival in the postanesthesia care unit significantly decreases the incidence of vomiting in children after tonsillectomy.