Children undergoing neurosurgical resection are at high risk for
postoperative nausea and vomiting.
Ondansetron, a selective serotonergic (5-HT3) antagonist, is effective in reducing
postoperative vomiting in several high-risk populations. In a prospective, randomized study, we compared the prophylactic use of intravenous
ondansetron, 0.15 mg/kg, versus placebo for the prevention of
emesis in 60 children, aged 2-18 yr, undergoing
craniotomies for resective procedures. Patients with preoperative
emesis were excluded from the study. All patients were tracheally extubated at the conclusion of surgery, and each episode of
emesis during the first 24 postoperative hours was recorded. For the entire 24-h interval, the incidence of
emesis in children who received
ondansetron (57%) was not significantly different from that in those who received placebo (66%); however, in the first 8 h, the incidence was 25% (
ondansetron) vs 44% (placebo) (P = not significant). In those receiving placebo, there was no difference in
emesis between patients undergoing operations above versus below the tentorium. Although our sample size was too small to completely exclude any beneficial effect,
ondansetron appears ineffective in preventing
postoperative emesis in this patient population.