Effect of intravenous fluid therapy on postoperative vomiting in children undergoing tonsillectomy

• Published in: British journal of anaesthesia : BJA Vol. 110; no. 4; pp. 607 - 614
• Main Authors: Elgueta, M.F., Echevarría, G.C., De la Fuente, N., Cabrera, F., Valderrama, A., Cabezón, R., Muñoz, H.R., Cortinez, L.I.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-04-2013; Oxford University Press
• Subjects: Anesthesia Recovery Period; Anesthesia, General; Antiemetics - therapeutic use; Child; Child, Preschool; Cost-Benefit Analysis; Female; Fluid Therapy - economics; Fluid Therapy - methods; Humans; Infant; Logistic Models; Male; nausea, anaesthetic factors; paediatrics; PONV; Postoperative Nausea and Vomiting - economics; Postoperative Nausea and Vomiting - epidemiology; Postoperative Nausea and Vomiting - therapy; Tonsillectomy - adverse effects; Tonsillectomy - economics; Treatment Outcome; vomiting, antiemetics; paediatrics; PONV; nausea, anaesthetic factors; vomiting, antiemetics
• ISSN: 0007-0912; 1471-6771
• DOI: 10.1093/bja/aes453

Postoperative vomiting (POV) is one of the most frequent complications of tonsillectomy in children. The aim of this study was to evaluate the antiemetic effect of super-hydration with lactated Ringer's solution in children undergoing elective otorhinolaryngological surgery.
One hundred ASA I–II children, aged 1–12 yr, undergoing elective tonsillectomy, with or without adenoidectomy, under general anaesthesia were studied. Induction and maintenance of anaesthesia were standardized with fentanyl, mivacurium, and sevoflurane in N2O/O2. Subjects were assigned to one of the two groups: 10 ml kg−1 h−1 lactated Ringer's solution or 30 ml kg−1 h−1 lactated Ringer's solution. A multivariable logistic regression was used for assessing the effects of super-hydration on POV (defined as the presence of retching, vomiting, or both). A value of P<0.05 was considered statistically significant.
During the first 24 h postoperative, the incidence of POV decreased from 82% to 62% (relative reduction of 24%, P=0.026). In the adjusted logistic regression model, subjects in the 10 ml kg−1 h−1 group had an odds ratio of POV that was 2.92 (95% confidence interval: 1.14, 7.51) for POV compared with subjects in the 30 ml kg−1 h−1 group.
Intraoperative administration of 30 ml kg−1 h−1 lactated Ringer's solution significantly reduced the incidence of POV during the first 24 h postoperative. Our results support the use of super-hydration during tonsillectomy, as an alternative way to decrease the risk of POV in children.