BJA Advance Access originally published online on September 26, 2006
British Journal of Anaesthesia 2006 97(5):593-604; doi:10.1093/bja/ael256
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Prophylaxis of postoperative vomiting in children undergoing tonsillectomy: a systematic review and meta-analysis
1 Department of Anaesthesia and Pain Management Royal Children's Hospital and Murdoch Childrens Research Institute, Flemington Road Parkville, Melbourne, Australia 3052
2 Department of Anaesthesia and Pain Management Alfred Hospital and Monash University, Melbourne, Australia 3004.
3 School of Population Health University of Melbourne, Australia 3010
4 Department of Social Medicine University of Bristol, Canynge Hall, Whiteladies Road, Bristol BS8 2PR, UK
*Corresponding author: Department of Anaesthesia and Pain Management, Royal Children's Hospital, Flemington Road Parkville, Melbourne, Victoria 3052, Australia. E-mail: chris.bolton{at}rch.org.au
Postoperative vomiting (POV) remains one of the commonest causes of significant morbidity after tonsillectomy in children. A variety of prophylactic anti-emetic interventions have been reported, but there has only been a limited systematic review in this patient group. A systematic search was performed by using Cochrane Controlled Trials Register, MEDLINE and EMBASE to identify double-blind, randomized, placebo-controlled trials of prophylactic anti-emetic interventions in children undergoing tonsillectomy, with or without adenoidectomy. The outcome of interest was POV in the first 24 h. Summary estimates of the effect of each prophylactic anti-emetic strategy were derived using fixed effect meta-analysis. Where appropriate, dose–response effects were estimated using logistic regression and 22 articles were identified. Good evidence was found for the prophylactic anti-emetic effect of dexamethasone [odds ratio (OR) 0.23, 95% CI 0.16–0.33], and the serotinergic antagonists ondansetron (OR 0.36, 95% CI 0.29–0.46), granisetron (OR 0.11, 95% CI 0.06–0.19), tropisetron (OR 0.15, 95% CI 0.06–0.35) and dolasetron (OR 0.25, 95% CI 0.1–0.59). Metoclopramide was also found to be efficacious (OR 0.51, 95% CI 0.34–0.77). There is not sufficient evidence to suggest that dimenhydrinate, perphenazine or droperidol, in the doses studied, are efficacious, nor were gastric aspiration or acupuncture. In conclusion, dexamethasone and the anti-serotinergic agents appear to be the most effective agents for the prophylaxis for POV in children undergoing tonsillectomy.
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  R. G. Cox Anesthetic management of pediatric adenotonsillectomy Can J Anesth, December 1, 2007; 54(12): 1021 - 1025. [Full Text] [PDF]
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D. P. Stanley, C. M. Bolton, P. S. Myles, T. Nolan, and J. A. Sterne Metoclopramide as anti-emetic in paediatrics Br. J. Anaesth., March 1, 2007; 98(3): 406 - 407. [Full Text] [PDF]
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- Metoclopramide as anti-emetic in paediatrics
- David P Stanley
- British Journal of Anaesthesia, 27 Nov 2006 [Full text]
- Reply to Dr Stanley
- Christopher M Bolton
- British Journal of Anaesthesia, 7 Dec 2006 [Full text]