A comparison of the costs and efficacy of ondansetron and dolasetron in the prophylaxis of postoperative vomiting in pediatric patients undergoing ambulatory surgery

• Published in: Anesthesia and analgesia Vol. 97; no. 2; pp. 390 - 396
• Main Authors: OLUTOYE, Olutoyin, JANTZEN, Ellen C, ALEXIS, Rhonda, RAJCHERT, Donna, SCHREINER, Mark S, WATCHA, Mehernoor F
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott 01.08.2003
• Subjects: Ambulatory Surgical Procedures - economics; Anesthesia, General; Biological and medical sciences; Child; Child, Preschool; Digestive system; Double-Blind Method; Drug Costs; Female; Hospital Costs; Humans; Indoles - administration & dosage; Indoles - economics; Male; Medical sciences; Ondansetron - administration & dosage; Ondansetron - economics; Pharmacology. Drug treatments; Postoperative Nausea and Vomiting - economics; Postoperative Nausea and Vomiting - prevention & control; Quinolizines - administration & dosage; Quinolizines - economics; Human; Postoperative; Costs; Dolasetron; Nausea; Dose activity relation; Prevention; Chemotherapy; Vomiting; Surgery; Health economy; 5-HT3 Serotonine receptor; Digestive diseases; Complication; Ambulatory; Antagonist; Child; Antiemetic; Comparative study; Ondansetron
• ISSN: 0003-2999; 1526-7598
• DOI: 10.1213/01.ANE.0000072706.09194.5E

Postoperative vomiting (POV) after ambulatory surgery remains a major problem. We designed this study to determine the smallest dose of dolasetron equivalent to the Food and Drug Administration approved dose of ondansetron 100 micro g/kg IV, for the prophylaxis of POV in children undergoing surgery. In this double-blinded controlled study, 204 healthy ASA I-II children aged 2-12 yr, undergoing superficial ambulatory (day-case) surgery, were randomized to receive either ondansetron 100 micro g/kg IV, or dolasetron 45, 175, 350, or 700 micro g/kg IV during a standardized perioperative regimen. The primary end-point was the incidence of complete response, defined as the absence of POV symptoms. Costs were calculated from the perspective of the hospital using a previously described model. The incidence of early (0-6 h) and 24-h emesis was more frequent in the dolasetron 45 micro g/kg group compared with the dolasetron 350 and 700 micro g/kg groups and with the ondansetron group. Repeated POV occurred more often when dolasetron was used in a dose <350 micro g/kg. There were no significant differences in emesis rates between the dolasetron 175, 350, and 700 micro g/kg groups or between these groups and the ondansetron 100 micro g/kg group. The smallest dose of dolasetron with acceptable equivalent efficacy and patient satisfaction scores to ondansetron 100 micro g/kg was 350 micro g/kg. Institutional costs for managing POV were less with dolasetron 350 micro g/kg than with ondansetron. This randomized double-blinded dose-ranging study concluded that dolasetron, 350 micro g/kg IV, was the smallest dose that provided acceptable equivalent efficacy and patient satisfaction scores to ondansetron, 100 micro g/kg IV, for the prophylaxis of postoperative vomiting in children undergoing outpatient surgery. However, with this dose, the costs to the institution for managing postoperative vomiting were less.