BJA Advance Access published online on September 26, 2006
British Journal of Anaesthesia, doi:10.1093/bja/ael256
1 Department of Anaesthesia and Pain Management, Royal Children's Hospital and Murdoch Childrens Research Institute, Flemington Road Parkville, Melbourne, Australia 3052
* To whom correspondence should be addressed. 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.
Review Article
Prophylaxis of postoperative vomiting in children undergoing tonsillectomy: a systematic review and meta-analysis
C. M. Bolton 1 *, P. S. Myles 2, T. Nolan 3, and J. A. Sterne 4
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
C. M. Bolton, E-mail: chris.bolton{at}rch.org.au
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- Metoclopramide as anti-emetic in paediatrics
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