Ondansetron dose response curve in high-risk pediatric patients.

Abstract

STUDY OBJECTIVE:

To establish a dose-response relationship for ondansetron, and to evaluate any effects of oral premedication with metoclopramide in pediatric patients undergoing tonsillectomy and adenoidectomy and strabismus surgery.

DESIGN:

Prospective, randomized, double blind study.

SETTING:

University affiliated, 280-bed pediatric hospital.

PATIENTS:

320 ASA physical status l and II patients between the ages of 2 and 12 years undergoing tonsillectomy and adenoidectomy or strabismus surgery.

INTERVENTIONS:

Patients were randomized to eight investigational groups. Patients in all eight groups underwent a standard anesthetic. Groups 1, 2, 3, and 4 received intravenous (i.v.) saline or i.v. ondansetron at doses of 0.05 mg/kg, 0.1 mg/kg and 0.15 mg/kg, respectively. Groups 5, 6, 7, and 8 received oral metoclopramide 0.15 mg/kg as well as i.v. saline, and ondansetron 0.05 mg/kg, 0.1 mg/kg, or 0.15 mg/kg. Patients were evaluated for emetic episodes prior to and following discharge.

MEASUREMENTS AND MAIN RESULTS:

All doses of ondansetron 0.05 mg/kg, 0.1 mg/kg, and 0.15 mg/kg were significantly more effective than placebo in reducing the incidence of emesis prior to, following discharge, and during the first 24 postoperative hours (p < 0.001). There were no significant differences in the occurrence of emesis between the groups receiving ondansetron 0.05 mg/kg, 0.1 mg/kg, and 0.15 mg/kg. The addition of oral metoclopramide 0.15 mg/kg had no effect on the incidence of emesis in the ondansetron or placebo study groups.

CONCLUSIONS:

Ondansetron is an effective medication for the treatment and prevention of postoperative nausea and vomiting, and a dose of ondansetron 0.05 mg/kg is as effective as 0.1 mg/kg and 0.15 mg/kg. Metoclopramide 0.15 mg/kg has no effect on the incidence of postoperative nausea and vomiting.

• Authors: C D Lawhorn, P J Kymer, F C Stewart, J M Stoner, R Shirey, P Volpe
• Journal: Journal of clinical anesthesia (J Clin Anesth) Vol. 9 Issue 8 Pg. 637-42 (Dec 1997) ISSN: 0952-8180 [Print] United States
• PMID: 9438891 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial)

Chemical References

• Antiemetics
• Ondansetron
• Metoclopramide

Topics

• Adenoidectomy
• Antiemetics (administration & dosage, therapeutic use)
• Child
• Child, Preschool
• Dose-Response Relationship, Drug
• Double-Blind Method
• Female
• Humans
• Injections, Intravenous
• Male
• Metoclopramide (therapeutic use)
• Nausea (prevention & control)
• Ondansetron (administration & dosage, therapeutic use)
• Postoperative Complications (prevention & control)
• Risk Factors
• Strabismus (surgery)
• Tonsillectomy
• Vomiting (prevention & control)