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Management of postoperative vomiting in pediatric patients

机译：小儿患者术后呕吐的处理

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Postoperative vomiting remains a common complication of general anesthesia and occurs more frequently in children than adults. Prophylactic antiemetics have limited efficacy and have a potential for side effects. The new 5 HT3 antagonists are effective but expensive, while the older less expensive drugs such as droperidol have come under disrepute because of the potential for serious, life-threatening, cardiac arrhythmias. This review examines the literature to aid practicing anesthesiologists in the choice of patient who will benefit from prophylactic antiemetics.In this review we discuss the factors associated with postoperative vomiting that are and are not under the control of the anesthesiologist. The Consensus Panel recommendations for reducing the risks of postoperative vomiting and for the rational use of prophylactic antiemetics in selected cases are reviewed. The controversy over the 'black box warning' on the use of droperidol is discussed. Finally, the evidence supports the importance of choosing a drug from another class for rescue therapy when prophylaxis with one drug has failed.Anesthesiologists should practice evidence-based medicine in reducing the common anesthetic complication of postoperative vomiting by an individualized approach that balances the choice of drugs with the expected risk of postoperative vomiting for cost-effective management.
机译：术后呕吐仍然是全身麻醉的常见并发症，在儿童中比在成人中更常见。预防性止吐药的疗效有限，并且可能产生副作用。新的5种HT3拮抗剂是有效的，但价格昂贵，而较便宜的较老药物如氟哌利多则因严重，危及生命的心律不齐而备受争议。本文综述了有关文献，以帮助执业中的麻醉师选择可以从预防性止吐药中受益的患者。在本文中，我们讨论了与麻醉后呕吐相关的因素，这些因素是麻醉师无法控制的。审查了共识小组在某些情况下减少术后呕吐风险和合理使用预防性止吐药的建议。讨论了有关氟哌利多使用的“黑匣子警告”的争议。最后，证据支持在预防一种药物失败后从另一类药物中选择一种药物进行抢救治疗的重要性。麻醉医师应采用循证医学，通过个体化的方法来减少术后呕吐的常见麻醉并发症，以平衡选择药物的剂量。具有术后呕吐预期风险的药物，可进行成本有效的管理。

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