Comparison of Three Different Prophylactic Treatments of Postoperative Nausea and Vomiting (PONV) in Children

Tonsillectomy with or without adenoidectomy may be associated with severe postoperative nausea and vomiting (PONV). Causes are principally trigeminal nerve stimulation and presence of blood in the stomach. Consequences are disagreement, unsatisfactory, delayed discharge, and overnight admission in day-cases. More barely, patients may also have suture and esophagus rupture, aspiration of gastric contents, dehydration and electrolyte disturbances.

Several medications may prevent and treat PONV, such as steroids, antidopaminergic drugs and serotonin (5-HT3) antagonists. The objective of this study is to compare three prophylactic antiemetic treatments:

• dexamethasone alone (250 mcg/kg)
• dexamethasone (250 mcg/kg) + droperidol (10 mcg/kg)
• dexamethasone (250 mcg/kg) + ondansetron (150 mcg/kg).

The hypothesis is that the combination of dexamethasone and droperidol is as effective as the combination of dexamethasone and ondansetron, both of them being more effective than dexamethasone alone. Moreover, droperidol is cheaper than ondansetron and may be recommended as a first-line treatment.

Inclusion criteria

• children aged 2-10 y.
• children ASA 1-2
• weight > 15 kg
• tonsillectomy with or without adenoidectomy

Exclusion criteria

• intravenous induction
• contraindication to steroids
• contraindication to antidopaminergic drugs
• contraindication to serotoninergic antagonists
• administration of steroids, antidopaminergic drugs, or serotoninergic antagonists in the 24 hours before the surgery
• refusal of parents
• no-french speaking parents