Effect of Palonosetron monotherapy versus Palonosetron with Dexamethasone combination therapy for prevention of post operative nausea vomiting in children undergoing strabismus surgery
Background: Postoperative nausea and vomiting (PONV) is the most distressing symptom reported in 40 88% of patients subsequent to strabismus surgery. Newer antiemetic 5-HT3 receptor antagonist drugs palonosetron and its combination with dexamethasone for prevention PONV in chemotherapy patients having promising results, but has not been studied in children undergoing strabismus surgery.
Methodology: 120 patients were registered in this prospective, randomized double blind study. Group A received palonosetron 1.5 mcgkg-1 and Group B received an additional dose of Inj dexamethasone 0.25 mgkg-1 prior to anaesthesia. Post operative data of PONV and postoperative vomiting (POV) was recorded at pre defined intervals in different age groups.
Results: There is no difference of POV in both groups at different age groups. The incidence of post operative nausea in Group A was 44% and Group B was 11% (p=0.02).Considering the incidence of PONV in all age groups, our results showed that the overall incidence of PONV in Group A was found to be more than that with Group B (p 0.05). Also in age group 3 year to 9 year, the incidence of PONV was higher in Group A than Group B (p =0.01).The incidence of PONV was found to be 17% (6 out of 36), 21% (14 out of 68) and 6% (1 out of 16) when one, two and three extra ocular muscles were operated respectively(p=0.39).
Conclusion: Palonosetron with dexamethasone combination therapy is recommended to be used in children age > 3years undergoing strabismus surgery.
Lin DM, Furst SR, Rodarte A. A double-blinded comparison of metoclopramide and droperidol for prevention of emesis following strabismus surgery.
Anesthesiology 1992; 76: 357-61.
Schumann R, Polaner DM. Massive subcutaneous emphysema and sudden airway compromise after postoperative vomiting. Anesth Analg 1999:796-97.
Gold BS, Kitz DS, Lecky JH, Neuhaus JM. Unanticipated admission to the hospital following ambulatory surgery. JAMA 1989; 262:3008-10.
Madan R, Bhatia A, Chakithandy S, Subramaniam R, Rammohan G, Deshpande S et al. Prophylactic Dexamethasone for postoperative nausea and vomiting in pediatric strabismus surgery: a dose ranging and safety evaluation study. Anesth Analg 2005; 100: 1622-6.
Rojas C, Thomas AG, Alt J, Stathis M, Zhang J, Rubenstein EB et al. Palonosetron triggers 5-HT receptor internalization and causes prolonged inhibition of receptor function. Eur J Pharmacol 2010; 626:193-99.
Wang JJ, Ho ST, Tzeng JI, Tang CS. The effect of timing of Dexamethasone administration on its efficacy as a prophylactic antiemetic for postoperative
nausea and vomiting. Anesth Analg 2000; 91:136-139.
Saito M, Aogi K, Sekine I, Yoshizawa H, Yanagita Y, Sakai H et al. Palonosetron plus Dexamethasone versus granisetron plus Dexamethasone for prevention of nausea and vomiting during chemotherapy: a double-blind, double-dummy, randomised, comparative phase III trial. Lancet Oncol 2009; 10: 115-24.
Abramowitz MD, Oh TH, Epstein BS, Ruttimann UE, Friendly DS. The antiemetic effect of droperidol following outpatient strabismus surgery in children. Anesthesiology 1983; 59: 579-83.
Apfel CC, Korttila K, Abdalla M, Biedler A, Kranke P, Pocock SJ et al. An international multicenter protocol to assess the single and combined benefits of antiemetic interventions in a controlled clinical trial of a 2x2x2x2x2x2 factorial design (IMPACT), Control Clin Trials 2003; 24:736-51.
Singh S, Sethi N. Neuroanesthesia and pregnancy: Uncharted waters. Med J Armed Forces India. In press 2018. [doi: 10.1016/j.mjafi.2018.10.001]
Scuderi PE, James RL, Harris L, Mims GR. Multimodal antiemetic management prevents early postoperative vomiting after outpatient laparoscopy.
Anesth Analg 2000; 91:1408-14.
Rose JB, Watcha MF. Postoperative nausea and vomiting in paediatric patients. Br J Anaesth 1999; 83:104-17.
Kovac AL. Management of postoperative nausea and vomiting in children. Paediatr Drugs 2007; 9:47-69.
Sossai R, Johr M, Kistler W et al. Postoperative vomiting in children: a persisting unsolved problem. Eur J Pediatr Surg 1993; 3:206-08.
Eberhart LH, Geldner G, Kranke, Morin AM, Schäuffelen A, Treiber H et al. The development and validation of a risk score to predict the probability of postoperative vomiting in pediatric patients. Anesth Analg 2004, 99:1630-37.
Welters ID, Graef M, Menges T, Beikirch C, Kaufmann H, Hempelmann G. Postoperative nausea and vomiting after Faden operation. Graefes Arch Clin Exp Ophthalmol 2000; 238:59-63
Rusch D, Happe W, Wulf H. Postoperative nausea and vomiting following stabismus surgery in children: inhalation anesthesia with sevoflurane-nitrous
oxide in comparison with intravenous anesthesia with propofol-remifentanil. Anaesthesist 1999; 48:80-88
Bicer C, Aksu R, Ulgey A, Madenoglu H, Dogan H, Yildiz K et al. Different doses of Palonosetron for prevention of PONV in children undergoing strabismus surgery. Drugs R D 2011: 11 1: 29-36.
Copyright (c) 2019 International Journal of Biomedical Research
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
- An author must submit Copyright form After acceptance of the article.