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J Anesth. 2007;21(3):311-6. Epub 2007 Aug 1.

Prevention of postoperative nausea and vomiting in children following adenotonsillectomy, using tropisetron with or without low-dose dexamethasone.

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Department of Anaesthesia, University Children's Hospital, Steinwiesstrasse 75, CH 8032 Zurich, Switzerland.



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.

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