Schroeter E, Schmitz A, Haas T, Weiss M, Gerber A C
Anästhesieabteilung, Kinderspital Zürich, Universitäts-Kinderkliniken, Steinwiesstr. 75, 8032, Zürich, Schweiz.
Anaesthesist. 2012 Jan;61(1):30-4. doi: 10.1007/s00101-011-1962-4. Epub 2012 Jan 12.
Droperidol had been used as an effective antiemetic since the 1970s but was withdrawn from the market in 2001 because of a black box warning about QT prolongation and possible cardiac arrhythmia after high doses. In the meantime the black box warning has seriously been questioned and parenteral droperidol has again been licensed in 2008. Because droperidol acts on dopaminergic receptors different to 5-HT(3) antagonists and dexamethasone, it could possibly serve as a rescue drug after failed postoperative nausea and vomiting (PONV) prophylaxis. Persistent PONV after the recommended prophylaxis is a significant problem in pediatric anesthesia but a satisfactory strategy has not yet been defined. Therefore a retrospective audit was performed in order to evaluate whether low-dose droperidol (10 µg/kgBW) would be an effective rescue drug for failed antiemetic prophylaxis.
The electronic anesthesia patient data base of the University Children's Hospital Zurich was searched from 2004-2009 for patients who received low-dose droperidol in the postanesthesia care unit as rescue therapy for persistent PONV after antiemetic prophylaxis. Based on the recorded electronic data the effectiveness of low-dose droperidol as PONV rescue therapy and possible side effects were analyzed.
A total of 338 patients who received droperidol were found from a total of 34,032 patients and the charts were analyzed. Of these patients 134 were excluded because they had received droperidol for indications other than PONV, 43 patients were excluded because they had not received antiemetic prophylaxis before droperidol and in 17 patients the data were incomplete, leaving 144 patients with an average age of 12.3 years (interquartile range IQR 9.5-15.2 years) for analysis. The upper range of ages resulted from patients with chronic diseases who were still being treated in the Children's Hospital. Low-dose droperidol was given because of persistent nausea to 59 patients (41%) and to 85 patients (59%) for persistent vomiting. Initial antiemetic prophylaxis and/or therapy had consisted of dexamethasone plus tropisetrone in 80 patients and tropisetrone or dexamethasone alone in 64 patients. In 128 patients (89%) rescue therapy with a median dose of 10.9 µg/kgBW droperidol was effective but vomiting persisted in 16 patients (11%). Sedation was the only side effect recorded and this was observed in 39 patients (27%).
Low-dose droperidol (10 µg/kgBW) was found to be effective as rescue medication in pediatric patients experiencing PONV despite various prophylactic antiemetic regimens. No neurological or cardiopulmonary side effects were recorded after this low dosage.
氟哌利多自20世纪70年代起就被用作有效的止吐药，但由于其黑框警告提示高剂量使用后会导致QT间期延长及可能发生心律失常，于2001年退出市场。与此同时，该黑框警告受到严重质疑，2008年胃肠外使用氟哌利多再次获得许可。由于氟哌利多作用于与5-羟色胺（5-HT）3拮抗剂和地塞米松不同的多巴胺能受体，它可能在术后恶心呕吐（PONV）预防失败后用作抢救药物。推荐的预防措施后仍持续存在的PONV是小儿麻醉中的一个重要问题，但尚未确定令人满意的策略。因此，进行了一项回顾性审计，以评估低剂量氟哌利多（10μg/kg体重）是否会是预防呕吐失败后的有效抢救药物。
检索苏黎世大学儿童医院2004年至2009年的电子麻醉患者数据库，查找在麻醉后护理单元接受低剂量氟哌利多作为PONV预防失败后持续性PONV抢救治疗的患者。根据记录的电子数据，分析低剂量氟哌利多作为PONV抢救治疗的有效性及可能的副作用。
在总共34032例患者中，共发现338例接受氟哌利多治疗的患者，并对其病历进行了分析。其中134例患者被排除，因为他们接受氟哌利多的适应证不是PONV；43例患者被排除，因为他们在使用氟哌利多之前未接受过止吐预防；17例患者的数据不完整，最终纳入144例平均年龄为12.3岁（四分位间距IQR 9.5 - 15.2岁）的患者进行分析。年龄上限来自仍在儿童医院接受治疗的慢性病患者。59例患者（41%）因持续性恶心、85例患者（59%）因持续性呕吐接受了低剂量氟哌利多治疗。初始止吐预防和/或治疗包括80例患者使用地塞米松加托烷司琼，64例患者单独使用托烷司琼或地塞米松。128例患者（89%）接受中位剂量为10.9μg/kg体重的氟哌利多抢救治疗有效，但16例患者（11%）仍持续呕吐。镇静是唯一记录到的副作用，39例患者（27%）出现该症状。
尽管采用了各种预防性止吐方案，但低剂量氟哌利多（10μg/kg体重）被发现对小儿PONV患者作为抢救药物有效力。该低剂量使用后未记录到神经或心肺副作用。
