Canadian Journal of Anaesthesia

, Volume 43, Issue 11, pp 1095–1099 | Cite as

RETRACTED ARTICLE: Antiemetic efficacy of granisetron and metoclopramide in children undergoing ophthalmic or ENT surgery

  • Yoshitaka Fujii
  • Hidenori Toyooka
  • Hiroyoshi Tanaka
Reports of Investigation

Abstract

Purpose

The purpose of this study was to compare the effectiveness of granisetron, metoclopramide and placebo in reducing the frequencies of retching and vomiting in children who had undergone strabismus repair and tonsillectomy with or without adenoidectomy.

Methods

In a randomized, double-blind study, 70 healthy subjects, 4–10 yr of age, were given a single dose of either placebo (saline, n = 24), metoclopramide 0.25 mg · kg−1 (n = 23) granisetron 40 μg · kg−1 (n = 23) iv over two to five minutes after the induction of anaesthesia. All subjects received inhalation anaesthesia with sevoflurane and nitrous oxide in oxygen. Rescue antiemetics were administered if two or more episodes of vomiting occurred. Acetaminophen pr or pentazocine iv was given as needed for postoperative pain. All subjects remained in hospital for two days. During the first three and the next 21 hr after anaesthesia, the frequencies of retching and vomiting were recorded by nursing staff.

Results

There was no difference among groups with regard to demographic characteristics, surgical procedures, anaesthetics administered, postoperative managements, or adverse effects. During 0–3 hr after anaesthesia, the frequencies of retching and vomiting were: placebo 62%, metoclopramide 22% and granisetron 13% (P < 0.05). The corresponding frequencies during 3–24 hr after anaesthesia were: placebo 50%, metoclopramide 39% and granisetron 13% (P < 0.05). Four children who had received placebo and three who had received metoclopramide required another rescue antiemetic.

Conclusion

Granisetron 40 μg · kg−1 is more effective than either metoclopramide or placebo in reducing the frequencies of postoperative retching and vomiting during the first 24 hr after anaesthesia in children who have undergone strabismus surgery and tonsillectomy with or without adenoidectomy.

Key words

Anaesthesia: paediatric Complications: vomiting Vomiting: antiemetics metoclopramide, granisetron Surgery: strabismus repair, tonsillectomy 

Résumé

Objectif

Comparer l’efficacité du granisetron, de la métoclopramide et d’un placebo sur la réduction de la fréquence des efforts pour vomir et des vomissements chez des enfants opérés pour strabisme et amygdalectomie avec ou sans adénoïdectomie.

Méthodes

Au cours d’une étude aléatoire, en double aveugle, 70 enfants en bonne santé âgés de 4 à 10 ans ont reçu en une seule dose, soit un placebo (n = 24), soit de la métaclopramide 0,25 mg · kg−1 (n = 23), soit du granisetron 40 μg · kg−1 (n = 23) iv sur une période de deux à cinq minutes après l’induction de l’anesthésie. L’anesthésie était toujours constituée de sévoflurane par inhalation avec du protoxyde d’azote en oxygène. Des antiémétiques de sauvetage ont été administrés si deux épisodes ou plus de vomissements survenaient. Tous les sujets sont demeurés à l’hôpital pendant deux jours. À la troisième heure et à la vingt et unième heure après l’anesthésie, la fréquence des efforts pour vomir et des vomissements était enregistrée par le personnel infirmier.

Résultats

Les caractéristiques démographiques, les interventions, les anesthésiques administrés, les soins postopératoire et les complications ont été les même pour tous les groupes. Pendant les trois premières heures qui ont suivi l’anesthésie, la fréquence des effets pour vomir et des vomissements était comme suit: placebo 62%, métoclopramide 22% et granisetron 13% (P < 0,05). Les fréquences correspondantes pendant la période s’étendant de 3 à 24 h après l’anesthésie étaint: placebo 50%, métoclopramide 39% et granisetron 13% (P < 0,05). Quatre enfant qui avaient reçu le placebo et trois de ceux qui avaient reçu la métoclopramide ont eu besoin d’un antiémétique de sauvetage.

Conclusion

Le granisetron 40 μ · kg−1 est plus efficace que la métoclopramide et le placebo pour réduire la fréquence des efforts et des vomissements postopératoires pendant les 4 h qui suivent l’anesthésie chez des enfants opérés pour strabisme et amygdalectomie avec ou sans adénoïdectomie.

References

  1. 1.
    Bermudez J, Boyle EA, Miner WD, Sanger GJ. The anti-emetic potential of the 5-hydroxytryptamine3 receptor antagonist BRL43694. Br J Cancer 1988; 58: 644–50.PubMedCrossRefGoogle Scholar
  2. 2.
    Fujii Y, Tanaka H, Toyooka H. Granisetron reduces vomiting after strabismus surgery and tonsillectomy in children. Can J Anaesth 1996; 43: 31–8.Google Scholar
  3. 3.
    Fujii Y, Toyooka H, Tanaka H. Effective dose of granisetron for preventing postoperative emesis in children. Can J Anaesth 1996; 43: 660–4.PubMedCrossRefGoogle Scholar
  4. 4.
    Broadman LM, Ceruzzi W, Patane PS, Hannallah RS, Ruttimann U, Friendly D. Metoclopramide reduces the incidence of vomiting following strabismus surgery in children. Anesthesiology 1990; 72: 245–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Ferrari LR, Donlon JV. Metoclopramide reduces the incidence of vomiting after tonsillectomy in children. Anesth Analg 1992; 75: 351–4.PubMedCrossRefGoogle Scholar
  6. 6.
    Cohen SE, Woods WA, Wyner J. Antiemetic efficacy of droperidol and metoclopramide. Anesthesiology 1984; 60: 67–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Fujii Y, Tanaka H, Toyooka H. Reduction of postoperative nausea and vomiting with granisetron. Can J Anaesth 1994; 41: 291–4.PubMedCrossRefGoogle Scholar
  8. 8.
    Melnick B, Sawyer R, Karambelkar D, Phitayakorn P, Lim Uy NT, Patel R. Delayed side effects of droperidol after ambulatory general anesthesia. Anesth Analg 1989; 69: 748–51.PubMedCrossRefGoogle Scholar
  9. 9.
    Dupre LJ, Stieglitz P. Extrapyramidal syndromes after premedication with droperidol in children. Br J Anaesth 1980; 52: 831–3.PubMedCrossRefGoogle Scholar
  10. 10.
    Pandit UA, Malviya S, Lewis IH. Vomiting after outpatient tonsillectomy and adenoidectomy in children: the role of nitrous oxide. Anesth Analg 1995; 80: 230–3.PubMedGoogle Scholar
  11. 11.
    Abramowitz MD, Oh TH, Epstein BS, Ruttimann UE, Friendly DS. The antiemetic effect of droperidol following outpatient strabismus surgery in children. Anesthesiology 1983; 59: 579–83.PubMedCrossRefGoogle Scholar
  12. 12.
    Carithers JS, Gebhart DE, Williams JA. Postoperative risks of pediatric tonsilloadenoidectomy. Laryngoscope 1987; 97: 422–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Watcha MF, White PF. Postoperative nausea and vomiting. Its etiology, treatment, and prevention. Anesthesiology 1992; 77: 162–84.PubMedCrossRefGoogle Scholar
  14. 14.
    Kilpatrick GJ, Jones BJ, Tyers MB. The distribution of specific binding of the 5-HT3 receptor ligand [3H] GR65630 in rat brain using quantitative autoradiography. Neurosci Lett 1988; 94: 156–60.PubMedCrossRefGoogle Scholar
  15. 15.
    Carmicheal J, Cantwell BMJ, Edwards CM, et al. A pharmacokinetic study of granisetron (BRL 43694A), a selective 5-HT3 receptor antagonist: correlation with anti-emetic response. Cancer Chemother Pharmacol 1989; 24: 45–9.Google Scholar
  16. 16.
    Furue H, Oota K, Taguchi T, Niitani H. Clinical evaluation of granisetron against nausea and vomiting induced by anticancer drugs. (I) Optimal dose-finding study (Japanese). Journal of Clinical and Therapeutic Medicine 1990; 6: 49–61.Google Scholar
  17. 17.
    Lin DM, Furst SR, Rodarte A. A double-blinded comparison of metoclopramide and droperidol for prevention of emesis following strabismus surgery. Anesthesiology 1992; 76: 357–61.PubMedCrossRefGoogle Scholar
  18. 18.
    Falkson G, van Zyl AJ. A phase I study of new 5HT3-receptor antagonist, BRL43694A, an agent for the prevention of chemotherapy-induced nausea and vomiting. Cancer Chemother Pharmacol 1989; 24: 193–6.PubMedCrossRefGoogle Scholar
  19. 19.
    Korttila K, Kauste A, Auvinen J. Comparison of domperidone, droperidol, and metoclopramide in the prevention and treatment of nausea and vomiting after balanced general anesthesia. Anesth Analg 1979; 58: 396–400.PubMedCrossRefGoogle Scholar

Copyright information

© Canadian Anesthesiologists 1996

Authors and Affiliations

  • Yoshitaka Fujii
    • 1
  • Hidenori Toyooka
    • 1
  • Hiroyoshi Tanaka
    • 2
  1. 1.Department of Anaesthesiology and Critical Care MedicineTokyo Medical and Dental University School of MedicineTokyoJapan
  2. 2.Department of AnaesthesiologyToride Kyodo General HospitalIbarakiJapan
  3. 3.Critical Care and Respiratory Division, Royal Victoria HospitalMcGill UniversityMontréalCanada

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