Spanjer, V.M.P. (Vera-Maria Pavão) (2014) PONV prophylaxis in children undergoing ENT-surgery: dexamethasone vs combination therapy. thesis, Medicine.
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Abstract
Introduction: Postoperative nausea and vomiting (PONV) is a common phenomenon after pediatric ear-, nose-, throat- (ENT)-surgery, with incidences as high as 70% (1). Severe vomiting can lead to dehydration, bleeding and aspiration. Despite the use of prophylactic therapy, such as ondansetron and dexamethasone, the incidence of PONV in children remains high (2). More research has to be done to find the best individually fitted PONV prophylaxis in children. Objectives: The main objective is to determine the efficacy of dexamethasone combined with propofol and ondansetron compared to dexamethasone alone as prophylaxis for PONV in pediatric patients undergoing ENT-surgery. Methods: In this prospective observational cohort study, forty-one patients aged between 6 months and 12 years undergoing ENT-surgery were included. Depending on which anesthesiologist provided the anesthesia, one group of patients (n= 20) received dexamethasone 0,15 mg kg-1 at the beginning of the surgery and another group of patients (n=21) received dexamethasone 0,15 mg kg-1, a bolus of propofol 2 mg kg-1 and ondansetron 50 μg kg-1. All patients were given fentanyl 1.5 μg kg-1 and acetaminophen (paracetamol)10 mg kg-1 or metamizole (dipirona) 30 mg kg-1. Anesthesia was induced and maintained with sevoflurane. Nausea, episodes of vomiting, the level of agitation and complications were documented thirty minutes after surgery. Twenty-four hours after the patient's discharge, a qualified nurse contacted the parents by telephone to inquire about the occurrence of nausea and vomiting 2 hours and 24 hours after the surgery. To determine a relationship between the treatment received and the incidence of nausea and vomiting, we used a Chi-square or Fisher’s exact test. Results: There were no significant differences in gender, age, risk factors, type of surgery, duration of anesthesia and analgesia used between the two groups. Four patients (20%) in the group receiving dexamethasone experienced nausea and 5 patients (25%) had an episode of vomiting. These PONV outcomes were not significantly different (P=0.093) from the other group, where 3 patients (14,3%) experienced nausea and 1 patient retched (5%). The level of agitation was similar in both groups (P=0.675). There were no complications reported in this study. Conclusion: The results of this study demonstrate no significant difference in the incidence of PONV in both study groups. This pilot study demonstrates a trend towards a lower incidence of PONV in children undergoing ENT-surgery receiving dexamethasone combined with propofol and ondansetron compared to children receiving dexamethasone alone. Unfortunately, we were not able to determine a statistically significant difference because of a low number of patients included. Further research needs to be done, with a larger group of patients, to confirm this conclusion.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Kalmar, Dr. Alain |
| Supervisor name: | Rubio, Jorge MD and Arcila, Mario MD and University CES. Medellin, Colombia. |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:41 |
| Last Modified: | 25 Jun 2020 10:41 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/284 |
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