Dexamethasone-low dose ketamine combination versus droperidol low dose ketamine. A comparative study for their effect on postoperative nausea and vomiting and swallowing evoked pain after paediatric adenotonsillectomy

ABSTRACT

40 children aged [6 - 12] years ASA 1 and II scheduled for Adenotonsillectomy were randomly allocated to receive either ketamine [0.1 mg/ kg] IM 15 minutes before induction of anesthesia and dexamethasone [150 micro g/ kg] before the end of surgery [group I] or ketamine [0.1 mg/ kg] IM 15 minutes before induction plus droperidol 15 micro g/ kg before the end of surgery [group II]. General anesthesia was standardized for both groups where all children were given rectal diclofenac [2 mg/ kg] 20 minutes before end of surgery. Thiopental 5 mg/ kg was used as an induction agent and suxamethonium [1 mg/ kg] was used to facilitate tracheal intubation. Anesthesia was maintained with halothane 1-2% concentration supplemented with oxygen -nitrous oxide [40-60%] After the end of surgery, all children were transferred to post anesthesia care unit where a trained nurse blinded to the study observed [and after that in the ward] observed all episodes of nausea and vomiting during the first 24 hours. Also pain scores were assessed 1/2 hour, 1,2 and 3 hours after extubation and remaining of the first postoperative day. Time for first call analgesia, first oral intake and first adequate oral intake were observed during the first postoperative day. All episodes of postoperative nausea and vomiting were significantly lower in group I; pain scores were significantly lower in group I at all times compared to group II. Time for first call of analgesia was significantly longer in group 1 and time of oral intake and adequate oral intake were significantly shorter in group I compared to group II. We concluded that ketamine [0.1 mg/ kg] + dexamethasone [150 micro g/ kg] combination gave significant better results than [ketamine [0.1 mg] + droperidol combination as regards PONOV and pain relief during the first postoperative day in children undergoing elective adenotonsillectomy done on ambulatory basis