Free
Correspondence  |   May 1995
Ondansetron or Metoclopramide in Children Undergoing Tonsillectomy
Author Notes
  • Department of Anesthesiology, Alfred L. duPont Institute of the Nemours Foundation, 1600 Rockland Road, P. O. Box 269, Wilmington, Delaware 19899.
Article Information
Correspondence
Correspondence   |   May 1995
Ondansetron or Metoclopramide in Children Undergoing Tonsillectomy
Anesthesiology 5 1995, Vol.82, 1305-1306. doi:
Anesthesiology 5 1995, Vol.82, 1305-1306. doi:
To the Editor:—Furst and Rodarte [1 ] recently reported that 0.15 mg/kg intravenous ondansetron is highly effective in reducing post-tonsillectomy vomiting in children and that droperidol and metoclopramide are not effective. These data are significant because droperidol and metoclopramide have been reported to be effective prophylactic antiemetics in children. [2,3 ] However, contrary to the authors' introductory statement that “no studies to date have examined the use of ondansetron in children for the prevention of postoperative emesis,” numerous clinical investigations and abstracts on this subject are published. [4–7 ] In one of these reports, 0.15 mg/kg intravenous ondansetron is reported to decrease vomiting after tonsillectomy in children from 73%(of the placebo group) to 23%(of the ondansetron group). [4 ].
In addition, we question a premise of their experimental design. Specifically, the authors state that the dose of metoclopramide used in their study (0.5 mg/kg intravenously) was “selected from the literature” and has been shown effective in preventing postoperative emesis in children at high risk for this complication. However, in none of the references to this claim has the use of this dose of metoclopramide been studied in healthy children undergoing surgery. The authors attempt to further justify this relatively large dose of metoclopramide by stating that doses as large as 3 mg/kg intravenously are used for the prevention of chemotherapy-induced vomiting. [8 ] The authors fail to mention that this dose of metoclopramide (3 mg/kg intravenously) was part of an antiemetic regimen that included 25–50 mg intravenous diphenhydramine, decadron, and lorazepam. In another article coauthored by Furst and Rodarte, they state a reluctance to use more than 0.25 mg/kg metoclopramide because of the potential for extrapyramidal side effects. [9 ] Has the safety and efficacy of 0.5 mg/kg intravenous metoclopramide in children during the perioperative period been established? If not, were parents of subjects in this study apprised of the experimental nature of this dose of metoclopramide?
John B. Rose, M.D., Thalia M. Martin, M.D., Department of Anesthesiology, Alfred L. duPont Institute of the Nemours Foundation, 1600 Rockland Road, P. O. Box 269, Wilmington, Delaware 19899.
(Accepted for publication February 10, 1995.)
REFERENCES
Furst SR, Rodarte A: Prophylactic antiemetic treatment with ondansetron in children undergoing tonsillectomy. ANESTHESIOLOGY 81:799- 803, 1994.
Eustis S, Lerman J, Smith DR: Effect of droperidol pretreatment on post anesthetic vomiting in children undergoing strabismus surgery: The minimum effective dose. J Pediatr Ophthalmol Strabismus 24:165-169, 1987.
Ferrari LR, Donton JV: Metoclopramide reduces the incidence of vomiting after tonsillectomy in children. Anesth Analg 75:351-354, 1992.
Litman RS, Wu CL, Catanzaro FA: Ondansetron decreases emesis after tonsillectomy in children. Anesth Analg 78:178-181, 1994.
Ummenhofer W, Frei FJ, Kern C, Urwler A, Drewe J: Ondansetron reduces postoperative nausea and vomiting in children (abstract). ANESTHESIOLOGY 79:A1192, 1993.
Peterson MD, Bishop J, Tanner K: Comparison of droperidol and ondansetron for prevention of vomiting after strabismus surgery in children (abstract). Anesth Analg 76:S329, 1993.
Rose JB, Martin TM, Corddry DH, Zagnoey M, Ketrick RG: Ondansetron reduces poststrabismus repair vomiting in children (abstract). Anesth Analg 78:S368, 1994.
Grunberg SM, Hesketh PJ: Control of chemotherapy-induced emesis. N Engl J Med 329:1790-1796, 1993.
Lin DM, Furst SR, Rodarte A: A double-blinded comparison of metoclopramide and droperidol for the prevention of emesis following strabismus surgery. ANESTHESIOLOGY 76:357-361, 1992.