Hostname: page-component-78c5997874-m6dg7 Total loading time: 0 Render date: 2024-11-19T12:46:34.491Z Has data issue: false hasContentIssue false

Post-operative nausea and vomiting following paediatric day-case tonsillectomy: audit of the Epsom protocol

Published online by Cambridge University Press:  21 July 2011

P J Robb*
Affiliation:
Department of Otolaryngology, Epsom and St Helier University Hospitals NHS Trust, Epsom, UK
B N Ewah
Affiliation:
Department of Anaesthesia, Epsom and St Helier University Hospitals NHS Trust, Epsom, UK
*
Address for correspondence: Mr Peter J Robb, Department of Otolaryngology, Epsom and St Helier University Hospitals NHS Trust, Epsom KT18 7EG, UK E-mail: [email protected]

Abstract

Objective:

To audit a protocol for elective, day-case, paediatric ENT surgery, previously reported as enabling an overall post-operative nausea and vomiting rate of 2 per cent and a discharge rate of 100 per cent on the day of surgery.

Method:

The audit included 91 children (45 boys and 46 girls) aged three to 14 years. Forty-seven children underwent tonsillectomy, 36 adenotonsillectomy and eight tonsillectomy with postnasal space examination; indications included recurrent tonsillitis, tonsillitis and nasal block, upper airway obstruction, and a combination of upper airway obstruction and recurrent tonsillitis.

Results:

No post-operative nausea or vomiting was recorded in any of the children on the day of surgery, and no discharges were delayed. The reactionary haemorrhage rate was 1 per cent and the secondary haemorrhage rate 3.3 per cent.

Conclusion:

These findings have implications for the safe same-day discharge of children following tonsillectomy.

Type
Main Articles
Copyright
Copyright © JLO (1984) Limited 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Department of Health. Day surgery – Report by the Day Surgery Task Force. NHS Management Executive, H93/977. London: HMSO, 1993Google Scholar
2Brown, PM, Fowler, S, Ryan, R, Rivron, R. ENT day surgery in England and Wales. An audit by the Royal College of Surgeons (Eng.) Comparative Audit Service. J Laryngol Otol 1998;112:161–5CrossRefGoogle ScholarPubMed
3Edler, AA, Mariano, ER, Golianu, B, Kuan, C, Pentcheva, K. An analysis of factors influencing postanesthesia recovery after pediatric ambulatory tonsillectomy and adenoidectomy. Anesth Analg 2007;104:784–9CrossRefGoogle ScholarPubMed
4Ewah, BN, Robb, PJ, Raw, M. Postoperative pain, nausea and vomiting following paediatric day-case tonsillectomy. Anaesthesia 2006;61:116–22CrossRefGoogle ScholarPubMed
5Wong, D, Baker, C. Pain in children: comparison of assessment scales. Paediatr Nurs 1988;14:9–17Google ScholarPubMed
6Skilbeck, C, Tweedie, D, Lloyd-Thomas, A, Albert, D. Suction diathermy for adenoidectomy: complications and risk of recurrence. Int J Pediatr Otorhinolaryngol 2007;71:917–20Google Scholar
7National Institute for Health and Clinical Excellence. Suction Diathermy Adenoidectomy. Interventional Procedure Guidance (IPG 328). London: National Institute for Health and Clinical Excellence, 2009Google Scholar
8Temple, R, Timms, M. Paediatric coblation tonsillectomy. Int J Pediatr Otorhinol 2001;61:195–8Google Scholar
9van der Meulen, J. Tonsillectomy technique as a risk factor for postoperative haemorrhage. Lancet 2004;9435:697702CrossRefGoogle Scholar
10National Institute for Health and Clinical Excellence. Electrosurgery (Diathermy and Coblation) for Tonsillectomy. Interventional Procedure Guidance (IPG 150). London: National Institute for Health and Clinical Excellence, 2005Google Scholar
11Harding, J. Is there a role for intravenous paracetamol in postoperative pain relief? Pharmacy in Practice 2009;19:6271Google Scholar
12Royal College of Surgeons of England. National Prospective Tonsillectomy Audit Final Report. British Association for Otolaryngology – Head and Neck Surgery and The Clinical Effectiveness Unit, RCS(Eng.). London: Royal College of Surgeons of England, 2004Google Scholar
13Aouad, MT, Siddik, SS, Rizk, LB, Zaytoun, GM, Baraka, AS. The effect of dexamethasone on postoperative vomiting after tonsillectomy. Anesth Analg 2001;92:636–40CrossRefGoogle ScholarPubMed
14Heatley, DG. Perioperative intravenous steroid treatment and tonsillectomy. Arch Otolaryngol Head Neck Surg 2001;127:1007–8Google Scholar
15Fazel, MR, Yegane-Moghaddam, A, Forghani, Z, Aghadoost, D, Mahdian, M, Fakharian, E. The effect of dexamethasone on postoperative vomiting and oral intake after adenotonsillectomy. Int J Pediatr Otorhinolaryngol 2007;71:1235–8CrossRefGoogle ScholarPubMed
16Cohen, IT. An overview of the clinical use of ondanestron in preschool age children. Therapeutics and Clinical Risk Management 2007;3:333–9Google Scholar
17Bolton, CM, Myles, PS, Nolan, T, Sterne, JA. Prophylaxis of postoperative vomiting in children undergoing tonsillectomy: a systematic review and meta-analysis. Br J Anaesth 2006;97:593604CrossRefGoogle ScholarPubMed
18Liechti, M, Feurer, R, Gross, D, Schmitz, A, Stutz, K, Gerber, A et al. Prevention of postoperative nausea and vomiting in children following adenotonsillectomy, using tropisetron with or without low-dose dexamethasone. J Anesth 2007;21:311–16Google Scholar
19Kim, MS, Coté, CJ, Cristoloveanu, C, Roth, AG, Vornov, P, Jennings, MA et al. There is no dose-escalation response to dexamethasone (0.0625–1.0 mg/kg) in pediatric tonsillectomy or adenotonsillectomy patients for preventing vomiting, reducing pain, shortening time to first liquid intake, or the incidence of voice change. Anesth Analg 2007;104:1052–8Google Scholar
20Czarnetzki, C, Elia, N, Lysakowski, C, Dumont, L, Landis, BN, Giger, R et al. Dexamethasone and risk of nausea and vomiting and postoperative bleeding after tonsillectomy in children: a randomized trial. J Am Med Assoc 2008;300:2621–30Google Scholar
21Robb, PJ. Dexamethasone and risk of PONV and postoperative bleeding after tonsillectomy in children. Clin Otolaryngol 2009;34:582–4Google Scholar
22Bennett, AMD, Emery, PJ. A significant reduction in paediatric post-tonsillectomy vomiting through audit. Ann R Coll Surg Engl 2008;90:226–30Google Scholar
23Royal College of Surgeons of England. Commission on the Provision of Surgical Services. London: Royal College of Surgeons of England, 1992Google Scholar
24Robb, PJ, Gowrinath, KG, Agyeman, K, Joseph, J. Paediatric tonsillectomy: parental experience and outcomes. J Laryngol Otol 2009;123:103–7CrossRefGoogle Scholar