DOI: http://dx.doi.org/10.18203/2319-2003.ijbcp20170349

A comparative clinical study of ondansetron and dexamethasone for prevention of postoperative vomiting in pediatric patients undergoing intra abdominal surgery

Lalit Mohan, Vinit Kumar Thakur, Prakash Kumar Dubey, Harihar Dikshit, Nitish Kumar, Lalit Kumar

Abstract


Background: This study aimed to compare the efficacy of intravenous ondansetron and dexamethasone for prevention of post-operative vomiting in pediatric patients whom underwent intra-abdominal surgery at Indira Gandhi institute of medical sciences, Patna.

Methods: A total of 40 eligible patients were included in the study. There were 20 patients in group 1 whom received i.v ondansetron (0.1 mg/kg), and 20 patients in group 2 received i.v Dexamethasone (1mg/kg) one minute prior to the induction of anaesthesia. Episodes of postoperative vomiting within first 24 hours of anaesthesia and thereafter in postoperative ward at different intervals was observed and recorded.

Results: Complete control of PONV (no emesis, no rescue treatment for 24 hours after administration of study agent) was achieved in 40% of cases in group I, in 42.25% of cases in group II, mild PONV was achieved in 7.5% of cases in group I, in 5.0% of cases in group II, moderate PONV was achieved in 2.5% of cases in group I, in 2.5% of cases in group II, and severe PONV was not found in any of the two group. There was no statistically significant difference between the groups1and 2 in terms of baseline characteristics and postoperative managements. Frequency of postoperative nausea and vomiting experiences were similar between the groups (p>0.05).

Conclusions: Single dose ondansetron 0.1 mg/kg and dexamethasone 0.5 mg/kg, given intravenously are equally effective agents for the control of PONV. Both drugs for the same indication do not seem to increase the antiemetic efficacy.


Keywords


Dexamethasone, General anaesthesia, Post operative nausea and vomiting (PONV), Pediatric surgery, Ondansetron

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References


de Orange FA, Marques J, Flores M, Borges PS. Dexamethasone versus ondansetron in combination with dexamethasone for the prophylaxis of postoperative vomiting in pediatric outpatients: a double-blind, randomized, placebo-controlled clinical trial. Paediatr Anaesth. 2012;22(9):890-96.

Knappe MR, Beecher HK. Post anaesthetic nausea, vomiting and retching: evaluation of antiemetic drugs dimenhydrinate, chlorpromazine and pentobarbital sodium. Journal of American Medical Association. 1956;160:376-85.

Kapur PA. The big “little problem”. Anesth Analg. 1991;73:243-5.

White PF, Watcha MF. Post operative nausea and vomiting: Its etiology and treatment. Anaesthesiology. 1992;77:162-84.

Mytes PS, Williams DL, Hendrata M. Patient satisfaction after anaesthesia and surgery: results of a prospective survey of 10811 patients. Br J Anaesth. 2000;84:6-10.

Shams TMA, Nahla E, Raga EI. Prophylactic small doses of mixture of 5-HT3 receptor antagonists and dexamethasone on PONV and adverse effects. EJICT. 2012;1:132-8.

Ho CM, Ho ST, Wang JJ, Tsai SK, Chai CY. Dexamethasone has a central antiemetic mechanism in decerebrated cats. Anesth Analg. 2004;99(3):734-9.

Holte K, Kehlet H. Perioperative single-dose glucocorticoid administration: pathophysiologic effects and clinical implications. J Am Coll Surg. 2002;195:694-712.

Wilson EB, Bass CS, Abrameit W, Roberson R, Smith RW. Metoclopramide versus ondansetron in prophylaxis of nausea and vomiting for laparoscopic cholecystectomy. Am J Surg. 2001;181:138-41.

McKenzie R, Kovac A, O’Connor T, Duncalf D, Angel J, Gratz l, et al. Comparison of ondansetron versus placebo to prevent postoperative nausea and vomiting in women undergoing journal of the College of Physicians and Surgeons Pakistan; 2008;18(5):265-9. Ambulatory gynecologic surgery. Anesthesiology. 1993;78:21-8.

Aapro MS, Alberts DS. Dexamethasone as an antiemetic in patients treated with cisplatin. N Engl J Med. 1981;305:520.

Fredrikson M, Hursti T, Fürst CJ, Steineck G, Börjeson S, Wikblom M, et al.Nausea in cancer chemotherapy is inversely related to urinary cortisol excretion. Br J Cancer. 1992;65:779-80.

Livera P, Trojano M, Simone IL, Zimatore GB, Logroscino GC, Pisicchio L, et al. Acute changes in blood-CSF barrier perselectivity to serum protein after intrathecal methotrexate and CNS irradiation. J Neurol. 1985;231:336-9.

Demirhan A, Tekelioglu YU, Akkaya A, Ozlu T, Yildiz I, Bayir H, et al. Antiemetic effects of dexamethasone and ondansetron combination during caesarean sections under spinal anaesthesia. Afr Health Sci. 2013;13(2):475-82.

Rabbani MZ, Khan MN, Qureshi R, Zubair M, Pervez MB. Does the added benefit of ondansetron over dexamethasone, to control post-operative nausea and vomiting, justify the added cost in patients undergoing tonsillectomy and adenotonsillectomy? J Pak Med Assoc. 2010;60(7):559-61.

Desai S, Santosh MCB, Annigeri R, Santoshi VB, Rao R. Comparison of the antiemetic effect of ramosetron with the combination of dexamethasone and ondansetron in middle ear surgery: A double-blind, randomized clinical study. SJA. 2013;7(3):254-8.