Children who undergo craniofacial operations are especially at risk of
postoperative nausea and vomiting. These operations are more complex than the
craniotomies for resective procedures.
Postoperative vomiting is a common occurrence that can delay recovery and result in
cerebrospinal fluid leak and
fistula formation in these patients.
Ondansetron, a selective serotonergic antagonist, is effective in reducing
postoperative nausea and vomiting in several high-risk populations. In a randomized, double-blind, placebo-controlled study, the authors compared the prophylactic use of intravenous
ondansetron 0.15 mg/kg with induction of
anesthesia versus a placebo of
normal saline 0.3 ml/kg with induction. A second dose was given 8 hours after the first dose. After surgery, episodes of
vomiting were recorded separately in 0 to 2 hours, 2 to 6 hours, 6 to 12 hours, 12 to 24 hours, and 24 to 48 hours.
Postoperative vomiting is significantly reduced in the
ondansetron group compared with the placebo group (P = 0.000258).
Ondansetron is effective in the prevention of
postoperative vomiting in the pediatric population undergoing craniofacial operations.