Canadian Journal of Anaesthesia

, Volume 42, Issue 3, pp 201–203 | Cite as

Midazolam reduces vomiting after tonsillectomy in children

  • William M. Splinter
  • Helen B. MacNeill
  • Eugene A. Menard
  • Elliot J. Rhine
  • David J. Roberts
  • Marion H. Gould
Reports of Investigation

Abstract

The purpose of this study was to assess the effect of midazolam on vomiting after tonsillectomy in children. We compared 215 children aged 1.5–14 yr undergoing tonsillectomy or adenotonsillectomy under general anaesthesia with nitrous oxide and halothane. In a double-blind fashion the subjects were administered either placebo or midazolam 75 μg · kg−1 iv after induction of anaesthesia. After the operation, the number of emetic episodes and the length of stay in hospital were recorded. The groups were similar with respect to age, weight, sex, mode of induction, duration of anaesthesia, surgical procedure, opioid administration and length of stay in the PAR and the Day Care Surgical Unit. The 108 midazolam-treated children had a lower incidence (42% vs 57%) of vomiting than the placebo group, P < 0.02. The placebo group had a higher incidence (9% vs 2%) of unscheduled admissions to hospital due to nausea and vomiting, P < 0.05. It is concluded that midazolam administered intravenously to children intraoperatively reduces vomiting after tonsillectomy.

Key words

anaesthesia: complications surgery: tonsillectomy, adenoidectomy vomiting: postoperative, antiemetics, midazolam 

Résumé

Cette étude vise à évaluer chez les enfants l’effet du midazolam sur les vomissements post-amygdalectomie. Nous étudions 215 enfants dont l’âge se situe entre 1,5 et 14 ans soumis à une amygdaleclomie ou à une adéno-amygdalectomie sous anesthésie générale à l’halothane et au protoxyde d’azote. Les sujets reçoivent en double aveugle soit un placebo soit du midazolam 75 μg · kg−1 après l’induction de l’anesthésie. Après l’intervention, le nombre d’épisodes émétiques et la durée du séjour à l’hôpital sont enregistrés. Les groupes sont comparables pour l’âge, le poids, le sexe, le mode d’induction, la durée de l’anesthésie, l’intervention chirurgicale, l’administration de morphinique et la durée du séjour en salle d’opération et à l’unité de chirurgie d’un jour. Les 108 enfants traités au midazolam vomissent moins (42% vs 57%) que le groupe placebo. L’incidence des admissions imprévues à l’hôpital pour nausées est vomissements est plus élevée dans le groupe placebo (9% vs 2%, P < 0,05). Nous concluons que l’administration iv de midazolam pendant l’intervention diminue l’incidence des nausées et des vomissements après l’amygdalectomie.

References

  1. 1.
    Cohen MM, Cameron CC, Duncan PG. Pediatric anesthesia morbidity and mortality in the perioperative period. Anesth Analg 1990; 70: 160–7.PubMedGoogle Scholar
  2. 2.
    Pandit U, Pryn S, Randel G, Levy L, Lewis I. Nitrous oxide does not increase postoperative nausea/vomiting in pediatric outpatients undergoing tonsillectomyadenoidectomy. Anesthesiology 1990; 73: A1245.Google Scholar
  3. 3.
    Splinter WM, Noel L, Roberts D, Rhine E, Bonn G, Clarke W. Antiemetic prophylaxis for strabismus surgery. Can J Ophthalmol 1994; 29: 224–6.PubMedGoogle Scholar
  4. 4.
    Splinter WM, Rhine EJ, MacNeill HB, et ai The effect of general anaesthesia on post-tonsillectomy vomiting. Can J Anaesth 1990; 37: S96.PubMedGoogle Scholar
  5. 5.
    Rowley MP, Brown TCK. Postoperative vomiting in children. Anaesth Intensive Care 1982; 10: 309–13.PubMedGoogle Scholar
  6. 6.
    Clarke RSJ. Nausea and vomiting. Br J Anaesth 1984; 56: 19–27.PubMedCrossRefGoogle Scholar
  7. 7.
    Grunwald ZVI, Schreiner MS, Parness J, Potsic WP, Templeton JJ. Droperidol decreases the incidence and the severity of vomiting after tonsiilectomy and adenoidectomy in children. Paediatric Anaesthesia 1994; 4: 163–7.CrossRefGoogle Scholar
  8. 8.
    Olynyk JK, Cullen SR, Leahy ME Midazolam: an effective antiemetic agent for cytotoxic chemotherapy (Letter). Med J Aust 1989; 150: 466.PubMedGoogle Scholar
  9. 9.
    Robins HI, Ershler WB, De Jongh L, et al. Antiemetic effect of intravenous diazepam in patients receiving cisdiamminedichloroplatinum II: a pilot study. Med Pediatr Oncol 1979; 7: 247–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Kearsley JH, Williams AM, Fiurmara A-M. Antiemetic superiority of lorazepam over oxazepam and methylprednisolone as premedicants for patients receiving cisplatincontaining chemotherapy. Cancer 1989; 64: 1595–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Khalil SN, Berry JM, Howard G, et al. The antiemetic effect of lorazepam after outpatient strabismus surgery in children. Anesthesiology 1992; 77: 915–9.PubMedCrossRefGoogle Scholar
  12. 12.
    Splinter WM, Semelhago L, Chou S. The reliability and validity of a modified CHEOPS pain score. Anesth Analg 1994; 78: S413.Google Scholar
  13. 13.
    Di Florio T. The use of midazolam for persistent postoperative nausea and vomiting. Anaesth Intensive Care 1992; 20: 383–6.PubMedGoogle Scholar
  14. 14.
    Takada K, Murai T, Kanayama T, Koshikawa N. Effects of midazolam and flunitrazepam on the release of dopamine from rat striatum measured byin vivo microdialysis. Br J Anaesth 1993; 70: 181–5.PubMedCrossRefGoogle Scholar
  15. 15.
    Litman RS, Wu CL, Catanzaro FA. Ondansetron decreases emesis after tonsiilectomy in children. Anesth Analg 1994; 78: 478–81.PubMedCrossRefGoogle Scholar
  16. 16.
    Ferrari LR, Donlon JV. Metoclopramide reduces the incidence of vomiting after tonsiilectomy in children. Anesth Analg 1992; 75: 351–4.PubMedCrossRefGoogle Scholar

Copyright information

© Canadian Anesthesiologists 1995

Authors and Affiliations

  • William M. Splinter
    • 1
    • 2
  • Helen B. MacNeill
    • 1
    • 2
  • Eugene A. Menard
    • 1
    • 2
  • Elliot J. Rhine
    • 1
    • 2
  • David J. Roberts
    • 1
    • 2
  • Marion H. Gould
    • 1
    • 2
  1. 1.Department of AnaesthesiaUniversity of OttawaOttawaCanada
  2. 2.Department of AnaesthesiaChildren’s Hospital of Eastern OntarioOttawaCanada

Personalised recommendations