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A factorial study of ondansetron, metoclopramide, and dexamethasone for emesis prophylaxis after adenotonsillectomy in children
Author(s) -
GUNTER JOEL B.,
McAULIFFE JOHN J.,
BECKMAN EILEEN C.,
WITTKUGEL ERIC P.,
SPAETH JAMES P.,
VARUGHESE ANNA M.
Publication year - 2006
Publication title -
pediatric anesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.704
H-Index - 82
eISSN - 1460-9592
pISSN - 1155-5645
DOI - 10.1111/j.1460-9592.2006.01952.x
Subject(s) - medicine , ondansetron , metoclopramide , anesthesia , dexamethasone , adenoidectomy , pediatrics , antiemetic , tonsillectomy , vomiting
Summary Background: We conducted a factorial study of emesis prophylaxis with ondansetron (OND), metoclopramide (MET), and dexamethasone (DEX). Methods: After informed parental consent, 240 children having adenotonsillectomy were randomized to one of 15 combinations of OND (0–60 μ g·kg −1 ), MET (0–400 μ g·kg −1 ), and/or DEX (0–500 μ g·kg −1 ). Using multivariable logistic regression, models were generated for the probability of emesis before discharge, after discharge and overall for 24 h. Results: Odds of emesis increased by a factor of three to four for children older than 7 years. Before discharge, odds of emesis decreased by factors of 0.29 for each 15 μ g·kg −1 of OND and 0.37 for each 100 μ g·kg −1 of MET. After discharge, odds of emesis decreased by a factor of 0.67 for each 125 μ g·kg −1 of DEX and increased by a factor of 3.5 for emesis before discharge. Over 24 h, odds of emesis decreased with OND, MET, and DEX (ORs as above). A negative interaction between OND and MET was seen before discharge and over 24 h, reducing the efficacy of their combination. Conclusions: We present novel study design and methods of analysis which are uniquely suited to studies of multiple interventions. Factorial design was a powerful tool, allowing simultaneous determination of dose–response relationships for three drugs and identifying a previously unreported negative interaction between OND and MET.