Wang Dongpi,Huang Wenfang,Zhao Jialian,et al.Efficacies of prophylactic ondansetron for postoperative nausea and vomiting in children undergoing ambulatory surgeries[J].Journal of Clinical Pediatric Surgery,,18():757-762.[doi:10.3969/j.issn.1671-6353.2019.09.010]
Efficacies of prophylactic ondansetron for postoperative nausea and vomiting in children undergoing ambulatory surgeries
- Keywords:
- Child; Anesthesia; Postoperative Nausea and Vomiting; Ambulatory Surgery; Enhanced Recovery After Surgery
- CLC:
- R726;R614
- Abstract:
- Objective To evaluate the safety and efficacy of prophylactic ondansetron,a 5-HT3 receptor antagonist,on postoperative nausea and vomiting(PONV)within 24h in children undergoing ambulatory surgeries.Methods A total of 2 002 children undergoing ambulatory surgeries were enrolled.The ondansetron group received prophylactic ondansetron while the control group did not.The anesthetic methods and surgical procedures were reviewed and the postoperative occurrences of nausea-vomiting within 24 hours assessed.Results There were no complications associated with ondansetron.The incidence of PONV and postoperative vomiting(POV)was significantly less in the ondansetron group than that in the control group(PONV 5.4% vs.8.8% in control,P<0.05; POV 3.2% vs.6.8% in control,P<0.05).In children with basal plus local infiltration anesthesia,the preventive efficacy of ondansetron seemed be superior to combined use of caudal block(OR=0.24(0.113-0.508)in PONV; OR=0.207(0.084-0.509)in POV).The best prophylactic efficacy was observed in ligation of traffic tube for hydrocele with caudal block[OR=0.067(0.007-0.618),P=0.002].Basal anesthesia plus caudal block[RR=1.712(1.097-2.672),P=0.017],high ligation of hernial sac[RR=1.946(1.262-3.000),P=0.002]and male[RR=1.829(1.081-3.095),P=0.023]were risk factors while prophylactic dosing of ondansetron served as a protective factor for POV.Conclusion Prophylactic ondansetron is both safe and effective for reducing the incidence of PONV and POV in children undergoing short-time ambulatory surgeries without related complications.The preventive efficacy of ondansetron improves medical comforts.It is recommended for preventing PONV/POV in children undergoing ambulatory surgeries,especially for those with inguinal hernia and hydrocele.
References:
1 Shaikh SI,Nagarekha D,Hegade G,et al.Postoperative nausea and vomiting:A simple yet complex problem[J].Anesth Essays Res,2016,10(3):388-396.DOI:10.4103/0259-1162.179310.
2 Ashok V,Bala I,Bharti N,et al.Effects of intraoperative liberal fluid therapy on postoperative nausea and vomiting in children-A randomized controlled trial[J].Paediatr Anaesth,2017,27(8):810-815.DOI:10.1111/pan.13179.
3 Apfel CC,Philip BK,Cakmakkaya OS,et al.Who is at risk for postdischarge nausea and vomiting after ambulatory surgery?[J] Anesthesiology,2012,117(3):475-486.DOI:10.1097/ALN.0b013e318267ef31.
4 Kovac AL.Comparative pharmacology and guide to the use of the serotonin 5-HT3 receptor antagonists for postoperative nausea and vomiting[J].Drugs,2016,76(18):1719-1735.DOI:10.1007/s40265-016-0663-3.
5 Rose JB,Watcha MF.Postoperative nausea and vomiting in paediatric patients[J].Br J Anaesth,1999,83(1):104-117.DOI:10.1093/bja/83.1.104.
6 Awad IT,Moore M,Rushe C,et al.Unplanned hospital admission in children undergoing day-case surgery[J].Eur J Anaesthesiol,2004,21(5):379-383.DOI:10.1017/s0265021504005058.
7 Edler AA,Mariano ER,Golianu B,et al.An analysis of factors influencing postanesthesia recovery after pediatric ambulatory tonsillectomy and adenoidectomy[J].Anesth Analg,2007,104(4):784-789.DOI:10.1213/01.ane.0000258771.53068.09.
8 Schaefer MS,Kranke P,Weibel S,et al.Total intravenous anesthesia vs single pharmacological prophylaxis to prevent postoperative vomiting in children:A systematic review and meta-analysis[J].Paediatr Anaesth,2017,27(12):1202-1209.DOI:10.1111/pan.13268.
9 Flubacher P,Fournier N,Cherpillod J,et al.A randomised controlled trial of placebo,droperidol or ondansetron to prevent nausea and vomiting after tonsillectomy in children receiving dexamethasone[J].Anaesthesia,2017,72(7):859-863.DOI:10.1111/anae.13907.
10 Apfel CC,Korttila K,Abdalla M,et al.A factorial trial of six interventions for the prevention of postoperative nausea and vomiting[J].N Engl J Med,2004,350(24):2441-2451.DOI:10.1056/NEJMoa032196.
11 Bourdaud N,Devys JM,Bientz J,et al.Development and validation of a risk score to predict the probability of postoperative vomiting in pediatric patients:the VPOP score[J].Paediatr Anaesth,2014,24(9):945-952.DOI:10.1111/pan.12428.
12 Gan TJ,Diemunsch P,Habib AS,et al.Consensus guidelines for the management of postoperative nausea and vomiting[J].Anesth Analg,2014,118(1):85-113.DOI:10.1213/ANE.0000000000000002.
13 Olutoye O,Jantzen EC,Alexis R,et al.A comparison of the costs and efficacy of ondansetron and dolasetron in the prophylaxis of postoperative vomiting in pediatric patients undergoing ambulatory surgery[J].Anesth Analg,2003,97(2):390-396.DOI:10.1213/01.ane.0000072706.09194.5e.
14 Yoshioka S,Takedatsu H,Fukunaga S,et al.Study to determine guidelines for pediatric colonoscopy[J].World J Gastroenterol,2017,23(31):5773-5779.DOI:10.3748/wjg.v23.i31.5773.
15 Gan TJ,Meyer TA,Apfel CC,et al.Society for Ambulatory Anesthesia guidelines for the management of postoperative nausea and vomiting[J].Anesth Analg,2007,105(6):1615-1628.DOI:10.1213/01.ane.0000295230.55439.f4.
16 Ducloyer JB,Couret C,Magne C,et al.Prospective evaluation of anesthetic protocols during pediatric ophthalmic surgery[J].Eur J Ophthalmol,2018.DOI:10.1177/1120672118804798.
17 Eberhart LH,Geldner G,Kranke P,et al.The development and validation of a risk score to predict the probability of postoperative vomiting in pediatric patients[J].Anesth Analg,2004,99(6):1630-1637.DOI:10.1213/01.ane.0000135639.57715.6c.
18 邓立军,李平,耿若帆,等.快速康复外科理念在小儿腹股沟疝日间手术中的应用[J].临床小儿外科杂志,2016,15(4):360-362.DOI:10.3969/j.issn.1671-6353.2016.04.015. Deng LJ,Li P,Geng RF,et al.Application of fast-track surgery for pediatric inguinal hernia[J].J Clin Ped Sur,2016,15(4):360-362.DOI:10.3969/j.issn.1671-6353.2016.04.015.
19 杜真,张溪英.小儿围术期舒适化技术的研究进展[J].临床小儿外科杂志,2018,17(2):150-154.DOI:10.3969/j.issn.1671-6353.2018.02.015. Du Z,Zhang XY.Research advances in the application of perioperative comfort-enhancing technology in children[J].J Clin Ped Sur,2018,17(2):150-154.DOI:10.3969/j.issn.1671-6353.2018.02.015.
20 周兴,钟素平,雷亨发, 等.右美托咪定联合舒芬太尼对下肢骨折手术患者术后镇痛效果及免疫功能的影响[J].中国医师进修杂志,2017,40(6):531-535.DOI:10.3760/cma.j.issn.1673-4904.2017.06.012. Zhou X, Zhong SP,Lei HF,et al.Effects of dexmedetomidine combined with sufentanil on postoperative analgesia and immune function in patients with lower extremity fracture surgery[J].Chin J Postgrad Med,2017,40(6):531-535.DOI:10.3760/cma.j.issn.1673-4904.2017.06.012.
21 张乃怿,高雨农.阿瑞匹坦联合地塞米松及昂丹司琼预防妇科肿瘤患者顺铂化疗引起的恶心呕吐的效果观察[J].实用妇产科杂志,2017,33(1):57-61. Zhang NZ,Gao YN.A combination of aprepitant,ondansetron and dexamethasone prevents emesis asociated with cisplatin-containing chemotherapy for patients with gynecological cancer[J].J Prac Obste Gynecol,2017,33(1):57-61.
22 饶关武.对比帕洛诺司琼与昂丹司琼用于头颈癌化疗止吐中的临床效果[J].湖北科技学院学报(医学版),2017,31(3):212-213.DOI:10.16751/j.cnki.2095-4646.2017.03.0212. Rao GW.Comparative clinical effects of palonosetron and ondansetron in chemotherapy and antiemetic of head and neck cancer[J].Journal of Hubei University of Science and Technology(Medical Sciences),2017,31(3):212-213.DOI:10.16751/j.cnki.2095-4646.2017.03.0212.
23 冯小娟,胡小霞,陈合波.电子止吐仪联合昂丹司琼预防乳腺癌延迟性化疗相关恶心、呕吐的效果观察[J].护理研究,2017,31(16):2039-2041.DOI:10.3969/j.issn.1009-6493.2017.16.037. Feng XJ,Hu XX,Chen HB.Effects of electronic antiemetic device combined with ondansetron on prevention of delayed chemotherapy-related nausea and vomiting in breast cancer[J].Chinese Nursing Research,2017,31(16):2039-2041.DOI:10.3969/J.issn.1009-6493.2017.16.037.
Memo
收稿日期:2019-01-13。
基金项目:国家自然科学基金（编号：81601358）；浙江省教育厅科研项目（编号：Y201328483）
通讯作者:黄寿奖,Email:CQ638@zju.edu.cn