Effects of anticholinergics on postoperative vomiting recovery, and hospital stay in children undergoing tonsillectomy with or without adenoidectomy

Background Nausea and vomiting are the most frequent problems after minor a mbulatory surgical procedures. The agents used to induce and maintain anest hesia may modify the Incidence of emesis, when neuromuscular blockade is an tagonized with anticholinesterases, atropine or glycopyrrolate Is used comm only to prevent bradycardia and excessive oral secretions. This study was d esigned to evaluate the effect of atropine and glycopyrrolate on postoperat ive vomiting in children. Methods: Ninety-three patients undergoing tonsillectomy with or without ade noidectomy were studied. After inhalation induction of anesthesia with nitr ous oxide, oxygen, and halothane, anesthesia was maintained with a nitrous oxide-oxygen mixture, halothane, morphine, and atracurium. Patients were ra ndomized to receive, in a double-blinded manner, either 15 mu g/kg atropine or 10 mu g/kg glycopyrrolate with 60 mu g/kg neostigmine to reverse neurom uscular blockade. Patient recovery, the incidence of postoperative emesis, antiemetic therapy, and the duration of postoperative hospital stay were as sessed. Results There were no significant differences in age, gender, weight, or di scharge time from the postanesthesia care unit or the hospital between the groups. Twenty-four hours after operation, the incidence of vomiting in the atropine group (56%) was significantly less than in the glycopyrrolate gro up (81%; P < 0.05), There was no significant difference between the atropin e and glycopyrrolate groups in the number of patients who required antiemet ics or additional analgesics, Conclusions: In children undergoing tonsillectomy with or without adenoidec tomy, reversal of neuromuscular blockade with atropine and neostigmine is a ssociated with a lesser incidence of postoperative emesis compared with gly copyrrolate and neostigmine.