Postoperative Vomiting in Children - Is Dextrose an Effective Prophylactic Anti-emetic?
Condition: Postoperative Vomiting
MeSH terms: Vomiting; Postoperative Nausea and Vomiting
Study type: Interventional

Summary: 
      The aim of this study was to investigate the efficacy of intraoperative intravenous dextrose
      in preventing POV in pediatric population undergoing dental day surgery.

      Post-operative vomiting (POV) in children is a frequent complication. Studies using
      intravenous (IV) fluids containing dextrose in the perioperative period have shown
      improvement of POV in adults. Similar studies have not been done in children.

      Knowing that Intravenous (IV) fluids containing dextrose are safe and commonly used in the
      paediatric population, this intervention could potentially reduce the amount of rescue
      antiemetic medications and improve recovery in same-day surgery paediatric patients.
    

Detailed description: 
      A non-inferiority randomized control trial of healthy children (3-9 years old) undergoing
      ambulatory dental surgery was conducted to investigate the efficacy of intraoperative IV
      fluids containing dextrose for antiemetic prophylaxis.

      The control group (146 participants) received dexamethasone (0.15 mg/kg IV) and ondansetron
      (0.05 mg/kg IV); the intervention group (144) received dexamethasone (0.15 mg/kg IV) and
      intravenous 5% dextrose in 0.9% normal saline (D5NS) as per a weight based maintenance rate.

      Patients underwent a general anesthetic maintained with a volatile anesthetic. There was not
      a standardized protocol for anesthetic induction and maintenance, and all types and doses of
      anesthetic medications were chosen and administered at the discretion of the
      anesthesiologist. Intraoperative administration of any other antiemetic medications
      constituted protocol violation and excluded the patient from analysis. There were no
      modifications to the planned dental procedure.

      Once IV access was established and the patient was intubated, the maintenance study solution
      was connected and infused throughout the operative period. Additional fluid (Ringer's
      Lactate) was available to the anesthesiologists to administer as per their preference.

      The study drug was administered to the patient by the anesthesiologist at the end of the
      procedure, when the throat packing was removed and the IV maintenance study solution was
      stopped. Before emergence from anesthesia, the researcher measured and recorded the patient's
      blood sugar via a chemstrip (AccuCheck aviva ®). Ringer's Lactate IV fluid, not part of study
      protocol, was continued in recovery based on the anesthesiologist's preference.

      All patients were transferred to the post-anesthetic care unit (PACU) at the end of the
      procedure. Discharge from the PACU was based on the Post Anesthetic Discharge Scoring System
      (PADSS) and institutional guidelines. Nursing staff and researchers recorded the presence and
      incidence of POV in the PACU. Analgesics and antiemetic agents were prescribed by the
      anesthesiologist during the recovery period and given according to nursing assessment based
      on institutional guidelines.

      Researchers phoned participants 24 hours after discharge to inquire about incidence of emesis
      and any need to seek medical attention after being discharged from the institution.
    

Intervention name(s): Dextrose (D5NS); Ondansetron (Control)
Intervention type(s): Drug; Drug
Intervention description(s): Solution Dextrose 5% in Normal Saline (D5NS) was used as a second antiemetic, at an intravenous maintenace rate (4 cc per Kg for first 10 Kg, 2 cc per Kg for next 10 Kg and 1 cc per Kg for the next Kg of weight) calculated based on the patient's weight; Ondansetron was used at a prophylactic dose (0,05 mg per Kg) based on patient's weight.
Other intervention name(s): Dextrose 5% in 0,9% Normal Saline; Zofran
Intervention MeSH terms: Ondansetron
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Prevention
Keywords: Postoperative vomiting; Children