Superior anti-emetic efficacy of granisetron-dexamethasone combination in children undergoing middle ear surgery.

Author(s): Gombar S, Kaur J, Kumar Gombar K, Dass A, Singh A

Affiliation(s): Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India.

Publication date & source: 2007-05, Acta Anaesthesiol Scand., 51(5):621-4.

Publication type:

Aim: To compare the effectiveness of granisetron and a granisetron-dexamethasone combination for the prevention of post-operative vomiting in children undergoing middle ear surgery. Methods: Ninety ASA physical status I or II children, aged 3-12 years, were randomly assigned to three groups of 30 each to receive a single dose of placebo (normal saline), granisetron 40 mug/kg or a combination of granisetron 40 mug/kg and dexamethasone 150 mug/kg intravenously after the induction of anaesthesia. Peri-operative anaesthetic care was standardized in all children. Post-operatively, during the first 24 h after anaesthesia, the frequencies of retching and vomiting and the incidence of adverse events were recorded. Rescue anti-emetic was administered if two or more episodes of emesis occurred. Post-operative pain was treated with morphine intravenously, followed by acetaminophen orally. Results: There were no differences between the treatment groups with regard to demographic data. A complete response (no retching/vomiting and no need for rescue anti-emetic) was achieved in 50%, 80% and 96.67% of children who received saline, granisetron and granisetron-dexamethasone, respectively (P < 0.05). Six children who received placebo and one who received granisetron alone required another rescue anti-emetic. The incidence of adverse events was comparable in the three groups. Conclusion: The prophylactic granisetron-dexamethasone combination was more effective than granisetron alone in the prevention of post-operative emesis during the first 24 h after anaesthesia in children undergoing middle ear surgery.