Impact of an antiemetic protocol on postoperative nausea and vomiting in children

The objective of the study was to demonstrate a decreased incidence of post operative nausea and vomiting (PONV) in children through the use of an anti emetic protocol. PONV was recorded in children (1.5-15 years) after inpatie nt surgery under general anaesthesia in a prospective, interview based sun ey. Group 1 consisted of children having surgery 1 month before the introdu ction of a formalized antiemetic protocol and group 2, 2 months after its i ntroduction. Data were collected over a 1-month period in each group. Outco me measures of nausea, emesis, antiemetic requirement and patient satisfact ion were monitored for the first 24-h postoperative period. There were 272 children enrolled: 138 in group 1 and 134 in group 2. There was a differenc e between the two groups for gender (P = 0.03), type of surgery (P = 0.017) , perioperative opioid (P = 0.003) and perioperative antiemetic use (P = 0. 024). However, multivariate analysis did not demonstrate an impact on outco me from these factors. The incidence of postoperative nausea (PON) and post operative vomiting (POV) following the introduction of the protocol was 36% and 34%, respectively. Moderate to severe nausea was decreased after intro duction of the protocol (18% versus 9%, P = 0.028) but moderate to severe v omiting failed to reach significance (19% versus 11%, P = 0.078). The propo rtion of children who had repeated nausea decreased after the introduction of the protocol (17% versus 8%, P = 0.02) but repeated episodes of vomiting remained unchanged (19% versus 14%). This was attributed to a significant increase in antiemetic prescribing by protocol in group 2 (10% versus 59%, P < 0.001). Patient satisfaction was high in both groups (85% versus 90%). The introduction of a postoperative antiemetic protocol improved prescribin g frequency. This resulted in a decreased incidence of moderate to severe P ON and a reduction in the number of patients with repeated nausea.