Efficacy of gastric aspiration in reducing posttonsillectomy vomiting

Objective: To determine the effectiveness of postoperative gastric decompre ssion in reducing the incidence and complications associated with vomiting following tonsillectomy. Design: A prospective, randomized controlled study. Setting: Private office and clinic of a university teaching hospital and re search center. Patients: Eighty pediatric patients ranging in age from 22 months to 11 yea rs, American Society of Anesthesiologists class I or II, undergoing tonsill ectomy with or without adenoidectomy were enrolled in the study. Six were e xcluded from the final analysis, 5 because of failure of the parents to com plete and return the data forms and I because of postoperative bleeding. Of the 74 patients included in the study, 35 were in the control group and 39 were in the study group. Interventions: The 39 patients in the study group underwent postoperative a spiration of gastric contents with an orogastric tube placed under direct v isualization while the patient was still under general anesthesia. The 35 p atients in the control group did not undergo gastric aspiration following s urgery. Main Outcome Measures: The incidence of vomiting, the number of episodes of vomiting before and after hospital discharge, the total volume of emesis, the postoperative length of stay, the need for rescue antiemetic prophylaxi s, and the number of readmissions to the hospital for persistent vomiting w ere,noted. Results: No statistically significant difference (P<.05) was noted between the control group and the study group for the percentage of patients experi encing vomiting (74% vs; 85%), the mean number of episodes of vomiting befo re (2.6 vs 2.8) and after (0.8 vs 0.7) hospital discharge, the mean volume of emesis (157 mL vs 222 mL), the postoperative length of stay (394 minutes vs 334 minutes), the percentage of patients requiring rescue antiemetics ( 34% [12 patients] vs 33% [13 patients]), and the percentage of unplanned ad missions because of vomiting (9% [3 patients] vs 15% [6 patients]). Conclusion: Our results indicate that gastric aspiration does not decrease the incidence of vomiting following tonsillectomy.