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Reply to Dr Stanley
- Christopher M Bolton (7 December 2006)
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Metoclopramide as anti-emetic in paediatrics
- David P Stanley (27 November 2006)
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Christopher M Bolton
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Dr Stanley raises concerns about the incidence of adverse reactions associated with the use of metoclopramide in chidren. He also points out that the British National Formulary warns agains its use in this age group. Whilst adverse reactions associated with the use of metoclopramide under anaesthesia are likely to be difficult to detect, its incidence has never been established. Intraoperative metoclopramide has been used widely at Melbourne's Royal Children's Hospital for the last fifteen years. There have not been any adverse reactions either during or after anaesthesia that have been causally linked to this practice. As such, in view of metoclopramide's cost and percieved effectiveness, this practice continues. A randomised controlled trial investigating the efficacy of metoclopramide in chidren has recently been submitted to the BJA for publication. Whilst we do not suggest that this trial provides evidence of safety, there were no adverse reactions detected. Conflict of Interest:None |
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David P Stanley, Anaesthetic SpR Birmingham School of Anaesthesia
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Editor- In their review of prevention of post-operative vomiting in children, Bolton et al (1) conclude that metoclopramide is efficacious. However, they neglect to mention its’ adverse effects which are particularly important in their studied paediatric group. Children, especially females, are at increased risk of acute dystonic reactions such as oculogyric crises. In the UK, there are specific restrictions on the use of metoclopramide in those under 20 years of age. Stated indications in the British National Formulary for Children (2) are severe intractable vomiting of known cause, vomiting associated with radiotherapy and cytotoxics, as an aid to gastro-intestinal intubation, a prokinetic in neonates and as pre-medication for diagnostic procedures. Therefore, I would urge caution before using such a drug, of moderate efficacy, as prophylaxis of postoperative vomiting in children. D. P. Stanley, Birmingham, UK E-mail: drdstanley@hotmail.com References 1 C. M. Bolton, P. S. Myles, T. Nolan and J. A. Sterne. Prophylaxis of postoperative vomiting in children undergoing tonsillectomy: a systematic review and meta-analysis. Br J Anaesth 2006; 97; 593-604 2 British National Formulary for Children. London: British Medical Association, Royal Pharmaceutical Society of Great Britain, the Royal College of Paediatrics and Child Health, and the Neonatal and Paediatric Pharmacists Group. 2006 Conflict of Interest:None declared |
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