积极的术后恶心呕吐预防性治疗可改善小儿腺样体扁桃体切除术的预后。

Aggressive Prophylactic Treatments for Postoperative Nausea and Vomiting Improve Outcomes in Pediatric Adenotonsillectomy Procedure.

作者信息

Demidovich Tatyana, Perez-Franco Orlando, Silvestrini-Suarez Marco, Yue Pin

出版信息

J Pediatr Pharmacol Ther. 2020;25(4):303-308. doi: 10.5863/1551-6776-25.4.303.

DOI:10.5863/1551-6776-25.4.303

PMID:32461743

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7243897/

Abstract

OBJECTIVE

Postoperative nausea and vomiting (PONV) is an extremely common side effect of general anesthesia that is difficult to manage. We tested a hypothesis that an aggressive prophylactic intervention with additional antiemetic drugs will reduce the incidence of PONV in a high-risk pediatric population undergoing adenotonsillectomy.

METHODS

In this retrospective study, pediatric patients undergoing adenotonsillectomy were screened for their risk factors for PONV. Patients who had 3 or more risk factors were identified as high risk and received either scopolamine patch preoperatively (for patients over 40 kg body weight) or diphenhydramine immediately postextubation in addition to ondansetron and dexamethasone, which are given routinely. Incidences of PONV within the first 60 minutes of a postanesthesia care unit (PACU) stay were collected and analyzed.

RESULTS

Overall postoperative vomiting rates during the first hour of a PACU stay were 4.3% for the group that was treated with dexamethasone and ondansetron only and 3.9% for the group that was treated with additional antiemetic drugs. Aggressive prophylactic management of PONV did reduce the rate of nausea and vomiting in a group of high-risk patients (p < 0.0001). The postoperative antiemetic drug usage was also decreased during the first 60 minutes of a PACU stay. However, the approach did not reduce the overall rate of PONV for the entire study population (p = 0.1612 for nausea and p = 0.0678 for vomiting).

CONCLUSION

Aggressive intraoperative management of PONV with additional antiemetic drugs are beneficial in high-risk pediatric population. Intraoperative diphenhydramine usage decreased the rate of PONV. However, preoperative scopolamine patch prevention did not improve PONV, which may be related to the drug's longer onset of action. Our result suggests that current clinical practice is undertreating PONV in pediatric patients receiving general anesthesia.

摘要

目的

术后恶心呕吐（PONV）是全身麻醉极为常见且难以处理的副作用。我们检验了一个假设，即使用额外的止吐药物进行积极的预防性干预将降低接受腺样体扁桃体切除术的高危儿科患者的PONV发生率。

方法

在这项回顾性研究中，对接受腺样体扁桃体切除术的儿科患者进行PONV风险因素筛查。有3个或更多风险因素的患者被确定为高危患者，除常规给予昂丹司琼和地塞米松外，体重超过40 kg的患者术前接受东莨菪碱贴片治疗，或拔管后立即给予苯海拉明治疗。收集并分析麻醉后护理单元（PACU）停留的前60分钟内的PONV发生率。

结果

仅接受地塞米松和昂丹司琼治疗的组在PACU停留的第一小时内总体术后呕吐率为4.3%，接受额外止吐药物治疗的组为3.9%。对PONV进行积极的预防性处理确实降低了一组高危患者的恶心和呕吐发生率（p<0.0001）。在PACU停留的前60分钟内，术后止吐药物的使用也有所减少。然而，该方法并未降低整个研究人群的总体PONV发生率（恶心发生率p = 0.1612，呕吐发生率p = 0.0678）。