Liechti Mirjam, Feurer Rita, Gross Dominique, Schmitz Achim, Stutz Katharina, Gerber Andreas, Weiss Markus
Department of Anaesthesia, University Children's Hospital, Steinwiesstrasse 75, CH 8032 Zurich, Switzerland.
J Anesth. 2007;21(3):311-6. doi: 10.1007/s00540-007-0523-0. Epub 2007 Aug 1.
Postoperative nausea and vomiting (PONV) after adenotonsillectomy in children is, in spite of the prophylactic administration of tropisetron, still a frequent event. The aim of this study was to evaluate the benefit of the additional systemic administration of low-dose dexamethasone (0.15 mg x kg(-1)) for the prevention of PONV.
With hospital ethics committee approval, we investigated children undergoing adenotonsillectomy receiving tropisetron (0.1 mg x kg(-1); maximum dose, 2 mg) or tropisetron (0.1 mg x kg(-1); maximum dose, 2 mg) plus dexamethasone (0.15 mg x kg(-1); maximum dose, 6 mg) intraoperatively. The incidence of vomiting episodes and the need for postoperative analgesics were recorded. Patient data were analyzed using the t-test and the chi(2) test (significance level of P = 0.05). Data values are means +/- SD.
Ninety children (39 girls and 51 boys), aged 5.6 +/- 2.8 years and weighing 21.9 +/- 8.8 kg, were enrolled in the study. The overall incidence of vomiting was 38.9% within the first 24 h (67 vomiting events) and 44.4% within 48 h postoperatively (87 vomiting events). The incidence of vomiting in the tropisetron-only group was 53.3% (24/45) at 24 h and 60% (27/45) at 48 h (24 h: P < 0.001 and 48 h: P = 0.04) and 24.4% (11/45) at 24 h and 28.9% (13/45) at 48 h in the tropisetron-dexamethasone group. The need for postoperative nalbuphine was double in patients treated with tropisetron-dexamethasone (0.61 mg +/- 0.36 mg x kg(-1) x 48 h(-1)) compared to that in patients receiving only tropisetron (0.31 mg +/- 0.28 mg x kg(-1) x 48 h(-1); P < 0.0001).
A low-dose bolus of dexamethasone (0.15 mg x kg(-1)) in combination with tropisetron, compared to tropisetron alone, considerably reduced the incidence of vomiting in children following pediatric adenotonsillectomy.
尽管预防性使用了托烷司琼，但儿童腺样体扁桃体切除术后的恶心呕吐（PONV）仍是常见情况。本研究旨在评估额外全身给予低剂量地塞米松（0.15 mg·kg⁻¹）预防PONV的益处。
经医院伦理委员会批准，我们调查了接受腺样体扁桃体切除术的儿童，术中给予托烷司琼（0.1 mg·kg⁻¹；最大剂量2 mg）或托烷司琼（0.1 mg·kg⁻¹；最大剂量2 mg）加地塞米松（0.15 mg·kg⁻¹；最大剂量6 mg）。记录呕吐发作的发生率和术后镇痛药物的使用需求。使用t检验和卡方检验（显著性水平P = 0.05）分析患者数据。数据值为均值±标准差。
90名儿童（39名女孩和51名男孩）纳入研究，年龄5.6±2.8岁，体重21.9±8.8 kg。术后24小时内呕吐的总体发生率为38.9%（67次呕吐事件），术后48小时内为44.4%（87次呕吐事件）。仅使用托烷司琼组在24小时时呕吐发生率为53.3%（24/45），48小时时为60%（27/45）（24小时：P < 0.001，48小时：P = 0.04）；托烷司琼加地塞米松组在24小时时为24.4%（11/45），48小时时为28.9%（13/45）。与仅接受托烷司琼治疗的患者相比，接受托烷司琼加地塞米松治疗的患者术后纳布啡的使用量增加一倍（0.61 mg±0.36 mg·kg⁻¹·48 h⁻¹对比0.31 mg±0.28 mg·kg⁻¹·48 h⁻¹；P < 0.0001）。
与单独使用托烷司琼相比，低剂量推注地塞米松（0.15 mg·kg⁻¹）联合托烷司琼可显著降低儿童腺样体扁桃体切除术后的呕吐发生率。
