Tropisetron plus subhypnotic propofol infusion is more effective than tropisetron alone for the prevention of vomiting in children after tonsillectomy

• Published in: Anaesthesia and intensive care Vol. 37; no. 1; pp. 54 - 59
• Main Authors: ERDEM, A. F, YORUK, O, SILBIR, F, ALICI, H. A, CESUR, M, DOGAN, N, AKTAN, B, SUTBEYAZ, Y
• Format: Journal Article
• Language: English
• Published: Edgecliff Anaesthesia Society of Anaesthetists 2009; Sage Publications Ltd. (UK); Sage Publications Ltd
• Subjects: Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthetics, Intravenous - administration & dosage; Antiemetics - administration & dosage; Biological and medical sciences; Child; Child, Preschool; Dosage and administration; Double-Blind Method; Drug Therapy, Combination; Female; Health aspects; Humans; Indoles - administration & dosage; Male; Medical sciences; Postoperative Nausea and Vomiting - prevention & control; Prevention; Propofol; Propofol - administration & dosage; Prospective Studies; Risk factors; Serotonin agonists; Tonsillectomy; Treatment Outcome; Tropisetron; Vomiting; Turkey; Human; subhypnotic propofol; Serotonin antagonist; Prevention; General anesthetic; Tonsillectomy; Vomiting; 5-HT3 Serotonine receptor; Digestive diseases; Anesthesia; Tropisetron; Propofol; Child; Antiemetic
• ISSN: 0310-057X; 1448-0271
• DOI: 10.1177/0310057x0903700106

This study evaluated the efficacy of tropisetron compared with tropisetron and a subhypnotic propofol infusion in preventing postoperative vomiting following tonsillectomy. One hundred and forty healthy children, aged four to 12 years, undergoing tonsillectomy were recruited in a randomised, double-blind study. After induction with sevoflurane, anaesthesia was maintained with sevoflurane and nitrous oxide. All patients received tropisetron (0.2 mg/kg up to 5 mg; intravenously) and fentanyl (2 microg/kg; intravenously) and were intubated after atracurium which was reversed with neostigmine (and atropine). The tropisetron-plus-propofol group received a single dose of propofol (1 mg/kg) before intubation and a continuous infusion of propofol throughout surgery at 15 microg/kg/min. Data for postoperative vomiting were grouped into zero to four and four to 24 hour time intervals. A P value of < 0.05 was considered statistically significant. The percentage of patients exhibiting a complete response (no retching or vomiting for 24 hours) was 47.1% (33/70) in the tropisetron-alone group and 72.8% (51/70) in the tropisetron-plus-propofol group (P = 0.002). The 0.257 absolute risk reduction of vomiting with the addition of propofol represents a number needed to treat of 3.87, and a risk ratio of 0.51 (95% CI 0.32 to 0.79). Significantly fewer patients vomited in the tropisetron-plus-propofol group than in the tropisetron-alone group during the zero to four post-surgery interval (P = 0.016), but the difference was not statistically significant for the four to 24 hour postoperative period (P = 0.116). Intraoperative subhypnotic propofol infusion combined with tropisetron is more effective than tropisetron alone in reducing postoperative vomiting after tonsillectomy in children.