Vomiting after adenotonsillectomy in children: a comparison of ondansetron, dimenhydrinate, and placebo.

UNLABELLED: We compared the effectiveness of ondansetron, dimenhydrinate, and placebo for the prevention of postoperative vomiting in children after adenotonsillectomy. In a randomized, placebo-controlled, double-blind study, 74 children, 2-10 yr of age scheduled for adenotonsillectomy as outpatients were given a single i.v. dose of ondansetron (0.1 mg/kg, n = 26), dimenhydrinate (0.5 mg/kg, n = 25), or placebo (saline, n = 23) at induction of anesthesia. The incidence of retching and vomiting (POV) and side effects observed 24 h after surgery were recorded. Demographic data were similar among the three groups. The 24-h incidence of POV was 42%, 79%, and 82% in the ondansetron, dimenhydrinate, and placebo groups, respectively (ondansetron compared with dimenhydrinate [P < 0.02] or placebo [P < 0.01]). The study was stopped after two children vomited large volumes of bloody fluid 9 and 22 h after surgery without previous signs of occult bleeding. Both children had received ondansetron. We conclude that ondansetron is superior to dimenhydrinate or placebo for the prevention of POV after adenotonsillectomy in children. Antiemetics may mask the signs of bleeding after adenotonsillectomy. IMPLICATIONS: I.v. ondansetron (0.1 mg/kg) is more effective than both dimenhydrinate and placebo in preventing vomiting after adenotonsillectomy in healthy children. However, antiemetics may also mask the presence of blood in the stomach by preventing vomiting, and this should be appreciated when adenotonsillectomy is performed on an outpatient basis.

Intermittent positive ventilation through a laryngeal mask in children: does it cause gastric dilatation?

After obtaining Ethics Committee approval and informed consent, sixty children, ASA Grade 1 or 2 and aged six months to ten years, were randomly allocated to receive intermittent positive pressure ventilation through either a laryngeal mask or a tracheal tube. Inflation pressures were maintained below 20 cm H2O, and gas aspirated from the stomach via an orogastric tube over a one h period. No large volumes were aspirated and no differences were detected between the groups. We conclude that healthy children over the age of six months can be safely ventilated through the laryngeal mask airway without gastric distension.

The incidence of minor sequelae following anaesthesia in children.

A survey was performed to estimate the incidence of the minor sequelae of anaesthesia in children. During an eight-month period 266 children, aged five years and over, were personally interviewed by an anaesthetist following recovery from anaesthesia. At interview the child was questioned to ascertain any morbidity suffered and record was made of the operation performed and the anaesthetic administered. Data were then evaluated, using multivariate analysis, to identify risk factors for the more common sequelae. This study revealed a higher incidence of the minor sequelae of anaesthesia in children than had previously been reported. The three most common sequelae recorded were nausea (48.1%), vomiting (35.0%), and sore throat (31.4%).

General anaesthesia in accident and emergency departments.

Potential problems with the provision of general anaesthesia in accident and emergency (A&E) departments were investigated by sending consultants in A&E a postal questionnaire asking for their views on the quality of the anaesthetic service available to their department. Of the 129 consultants replying, 31% had problems in obtaining an anaesthetist, 17% thought the first on-call anaesthetist was too inexperienced and 5% had experienced various other problems. Overall, 20% were unhappy with the service.

Analgesia for venous cannulation: a comparison of EMLA (5 minutes application), lignocaine, ethyl chloride, and nothing.

Three commonly available local anaesthetics were compared, in a controlled trial, for use before venous cannulation. The pain of application of the local anaesthetic, the pain of cannulation, and the rate of successful cannulations were compared. The value of EMLA cream applied for 5 min was questioned. Venous cannulation with a 20G venflon was found to be significantly more painful than the application of any of the local anaesthetics (P < 0.01). Lignocaine 1%, injected subcutaneously, and ethyl chloride spray significantly reduced the pain of venous cannulation (P < 0.01). The use of lignocaine did not result in significantly more failed cannulations than the control group. It was concluded that local anaesthesia should be used before venous cannulation, even for 20G cannulae.

Compartment syndrome in a child occurring after femoral artery cannulation.

Compartment syndromes have not been reported in association with femoral artery cannulation for invasive blood pressure monitoring in children. We report a case that presented atypically in a child admitted in extremis due to small bowel obstruction and who had a 20 G femoral arterial cannula sited during resuscitation. The compartment syndrome was diagnosed after repeated measurements of compartment pressures.

Technical note: the influence of using an atraumatic needle on the incidence of post-myelography headache.

The aim of this study was to investigate whether the incidence of headaches following myelography could be reduced by using a needle with an atraumatic tip. 107 patients were studied in a trial of 22 gauge atraumatic versus 22 gauge bevel tipped needles. In the first 3 days after myelography, there was a significant reduction in the incidence of headaches in patients in whom an atraumatic needle had been used.