Comparative study of orogastric suction and dexamethasone to reduce vomiting after pediatric tonsillectomy

Abstract EN

Objective: To compare the effect of gastric emptying with an orogastric tube and the effect of a single dose of dexamethasone on the incidence of postoperative vomiting in children undergoing tonsillectomy.

Methods: Two hundred and ten patients of both genders, aged 1.5-14 years, who were scheduled to undergo tonsillectomy with or without adenoidectomy were studied prospectively.

Patients were randomized into three groups.

Group I included patients who underwent gastric aspiration with an orogastric tube prior to extubation following surgery (n = 70).

Group II included patients who received dexamethasone 0.5 mg/kg intravenously (maximum dose 8 mg) after the induction of anesthesia and before surgery (n = 70).

Group III included patients who neither received dexamethasone nor underwent gastric aspiration (n = 70).

Data on the number of episodes of vomiting, total volume of emesis, administration of rescue prophylactic antiemetics were recorded.

Results: The incidence of early postoperative vomiting (before discharge from recovery room) was not significantly different between the three groups.

The incidence of vomiting during stay on the ward (late vomiting) was more frequent in group I and III.

The mean number of episodes of vomiting in the three groups was 2.4, 2.2 and 2.3 respectively.

The mean volume of emesis for the patients who experienced postoperative vomiting was similar in the three groups (183 ml, 176 ml and 180 ml respectively).

Prophylactic antiemetic rescues were required in 13% of group I, 4% in group II and 10% in group III.

The time to the first oral intake and duration of intravenous hydration was significantly shorter in the dexamethasone group than in the other two groups.

Conclusion: Prophylactic intra operative single dose of dexamethasone decreases the incidence of postoperative vomiting, and accelerates the return to normal diet in children undergoing tonsillectomy.

Aspiration of gastric contents with an orogastric tube does not decrease postoperative vomiting, mean number of vomiting episodes and the volume of emesis.

Routine use of orogastric tube placement for gastric aspiration following pediatric tonsillectomy is not advisable.