434 Pediatric acupuncture vomiting before hospital discharge. However, children in the droperidol group were noted to be significantly more restless post-operatively, as compared with children in the acupuncture alone group. An additional study among 187 children, aged 7–16 years, examined post-operative nausea and vomiting after general anesthesia and outpatient surgery by employing four study groups: (i) intravenous saline and P6 acupuncture, (ii) droperidol and P6 sham acupuncture, (iii) saline and sham acupuncture and (iv) saline and P6 sham acupuncture (83). Findings revealed a significantly lower incidence of PACU nausea and vomiting in the P6 group as compared with the sham group and the P6 sham group, but not the droperidol group. Schlager and colleagues (84) made several modifications to earlier methodologies (81,85) in order to test the efficacy of acupuncture for post-operative vomiting in a similar sample of children undergoing strabismus surgery. Their treatment group (n = 25, mean age = 6.5) received Korean hand acupressure, in which a disc is used to apply pressure to the Korean K-K9 acupoint, 30 min prior to the induction of anesthesia. The disc was secured in place for at least 24 h. In addition, this study employed a control group (n = 25, mean age = 6.5), which had tape, but no disc, placed over acupoints in order to simulate treatment. Results indicated a significant differ- ence in the incidence of post-operative vomiting between the two study groups, such that only 20% of patients in the treatment group, but 68% of control patients vomited after surgery. In contrast to the Yentis and Bissonette studies (81,85), interventions were administered while children were still awake, prior to the delivery of anesthesia. This strategy coincides with the adult literature that suggests anesthesia may mute the effects of acupuncture (86), as well as a meta-analysis suggesting that patients must be awake rather than anesthetized in order to receive the antiemetic benefits of acupuncture (87). Similar findings were observed in a study examining the effects of laser-stimulated acupuncture on post- operative vomiting among a sample of children undergoing strabismus surgery (79). Forty children were randomized to receive either low-level laser stimulation of acupoints at P6 (n = 20, mean age = 5.9), or placebo acupuncture in which an inactive laser was held over P6 (n = 20, mean age = 6.3). Laser and placebo acupuncture interventions were deliv- ered 15 min prior to the induction of anesthesia, as well as 15 min after arrival in the recovery room. A significant difference between study groups was observed; 85% of participants in the placebo group vomited 24 h after surgery, while only 25% of children who received laser acupuncture vomited during that time. Acupuncture has also been studied under outpatient conditions among children undergoing dental treatments with general anesthesia. Somri and colleagues (88) conducted a randomized prospective study of 90 children, aged 4–12 years. Their investigation employed three study groups including an ondansetron group (n = 30), which represented the standard of care to prevent post-operative vomiting, an acupuncture group (n = 30), which received bilateral needle insertions at two locations, including P6, prior to being transferred into the operating room and a placebo group (n = 30), which received pre-operative saline. Both the ondansetron and acupuncture groups had significantly fewer emetic episodes after discharge on the day of surgery, as compared with the placebo group, and reported higher satisfaction with anti-emetic treat- ment. In addition, a significantly higher proportion of children vomited during the day of or the day after surgery in the placebo group as compared with either the ondansetron or acupuncture groups. However, no sig- nificant differences were detected between the ondanse- tron and acupuncture groups in terms of nausea, vomiting, or overall satisfaction. Post-operative vomiting is also prevalent following pediatric tonsillectomy procedures. One study randomly assigned 90 children, aged 4–12 years, to one of three conditions: single dose administration of ondansetron following intubation, transcutaneous electrical stimula- tion of surface electrodes on several acupoints prior to induction of anesthesia and again in the post-anesthesia care unit (PACU), or a no-treatment control group (78). All children were discharged from the PACU to the day surgery care unit (DSCU) prior to returning home. No significant differences in terms of number of emetic episodes were detected between the ondansetron and acupuncture groups, however, both treatments were significantly better than the control group such that they evidenced fewer emetic episodes in the DSCU and on the day of surgery. In addition, the ondansetron sample reported significantly more clinical and sympto- matic side effects than either the acupuncture or control samples. Satisfaction ratings were significantly higher among the two treatment groups as compared with the control group. A more recent study examined the use of electro- acupuncture at P6 among 120 children following a tonsillectomy, aged 4–18 years (89). Participants were randomly assigned to an active acupuncture group, a sham acupuncture group, in which needles where inserted in acupoints not associated with antiemesis, or a no-needle control group. Findings revealed a significantly lower incidence of post-operative nausea and vomiting symptoms (PONV) in acupuncture group (63%) as compared with the control group (93%). No significant difference in PONV was observed between the sham acupuncture group (88%) and controls (93%). Although vomiting occurred in 63% of the acupuncture group, 88% in the sham group and 78% of the control group, these differences were not significant. Shenkman and colleagues (80) also investigated the use of acupressure and acupuncture in children undergoing