Splinter W M, Rhine E J, Roberts D W, Reid C W, MacNeill H B
Department of Anaesthesia, Children's Hospital of Eastern Ontario, University of Ottawa, Canada.
Can J Anaesth. 1996 Jun;43(6):560-3. doi: 10.1007/BF03011766.
To compare the incidence of vomiting following codeine or ketorolac for tonsillectomy in children.
We had planned to enrol 240 patients, aged 2-12 yr undergoing elective tonsillectomy into a randomized, single-blind study in University Children's Hospital. The study was terminated, after 64 patients because interim analysis of the data by a blinded non-study scientist concluded that the patients were at undue risk of excessive perioperative bleeding. After induction of anaesthesia by inhalation with N2O/halothane or with propofol 2.5-3.5 mg.kg-1 i.v., the children were administered 150 micrograms.kg-1 ondansetron and 50 micrograms.kg-1 midazolam. Maintenance of anaesthesia was with N2O and halothane in O2. Subjects were administered either 1.5 mg.kg-1 codeine im or 1 mg.kg-1 ketorolac i.v. before the commencement of surgery. Intraoperative blood loss was measured with a Baxter Medi-Vac Universal Critical Measurement Unit. Postoperative management of vomiting and pain was standardized. Vomiting was recorded for 24 hr after anaesthesia. Data were compared with ANOVA, Chi-Square analysis and Fisher Exact Test.
Thirty-five subjects received ketorolac. Demographic data were similar. The incidence of vomiting during the postoperative period was 31% in the codeine-group and 40% in the ketorolac-group. Intraoperative blood losses was 1.3 +/- 0.8 ml.kg-1 after codeine and 2.2 +/- 1.9 ml.kg-1 after ketorolac (mean +/- SD) P < 0.05. Five ketorolac-treated patients had bleeding which led to unscheduled admission to hospital, P < 0.05, Exact Test.
Preoperative ketorolac increases perioperative bleeding among children undergoing tonsillectomy without beneficial effects.
比较可待因或酮咯酸用于儿童扁桃体切除术后呕吐的发生率。
我们计划在大学儿童医院对240例年龄在2至12岁、接受择期扁桃体切除术的患者进行一项随机单盲研究。在64例患者入组后，该研究终止，因为一位不知情的非研究科学家对数据进行的中期分析得出结论，患者围手术期出血过多的风险过高。通过吸入N2O/氟烷或静脉注射2.5 - 3.5mg·kg-1丙泊酚诱导麻醉后，给儿童静脉注射150μg·kg-1昂丹司琼和50μg·kg-1咪达唑仑。麻醉维持采用N2O和O2中的氟烷。在手术开始前，受试者接受1.5mg·kg-1可待因肌肉注射或1mg·kg-1酮咯酸静脉注射。术中失血用百特医疗通用临界测量仪测量。术后呕吐和疼痛的处理标准化。麻醉后记录24小时内的呕吐情况。数据采用方差分析、卡方检验和Fisher精确检验进行比较。
35例受试者接受了酮咯酸。人口统计学数据相似。术后期间可待因组呕吐发生率为31%，酮咯酸组为40%。可待因给药后术中失血量为1.3±0.8ml·kg-1，酮咯酸给药后为2.2±1.9ml·kg-1（均值±标准差），P<0.05。5例接受酮咯酸治疗的患者发生出血，导致非计划住院，P<0.05，精确检验。
术前使用酮咯酸会增加接受扁桃体切除术儿童的围手术期出血，且无有益作用。
