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AMBULATORY ANESTHESIA

A Comparison of the Costs and Efficacy of Ondansetron and Dolasetron in the Prophylaxis of Postoperative Vomiting in Pediatric Patients Undergoing Ambulatory Surgery

Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania

Address correspondence to Mehernoor F. Watcha, MD, Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, 34th St. and Civic Center Blvd., Philadelphia, PA 19104. Address e-mail to watcha{at}email.chop.edu

Postoperative vomiting (POV) after ambulatory surgery remains a major problem. We designed this study to determine the smallest dose of dolasetron equivalent to the Food and Drug Administration approved dose of ondansetron 100 µg/kg IV, for the prophylaxis of POV in children undergoing surgery. In this double-blinded controlled study, 204 healthy ASA I–II children aged 2–12 yr, undergoing superficial ambulatory (day-case) surgery, were randomized to receive either ondansetron 100 µg/kg IV, or dolasetron 45, 175, 350, or 700 µg/kg IV during a standardized perioperative regimen. The primary end-point was the incidence of complete response, defined as the absence of POV symptoms. Costs were calculated from the perspective of the hospital using a previously described model. The incidence of early (0–6 h) and 24-h emesis was more frequent in the dolasetron 45 µg/kg group compared with the dolasetron 350 and 700 µg/kg groups and with the ondansetron group. Repeated POV occurred more often when dolasetron was used in a dose <350 µg/kg. There were no significant differences in emesis rates between the dolasetron 175, 350, and 700 µg/kg groups or between these groups and the ondansetron 100 µg/kg group. The smallest dose of dolasetron with acceptable equivalent efficacy and patient satisfaction scores to ondansetron 100 µg/kg was 350 µg/kg. Institutional costs for managing POV were less with dolasetron 350 µg/kg than with ondansetron.

IMPLICATIONS: This randomized double-blinded dose-ranging study concluded that dolasetron, 350 µg/kg IV, was the smallest dose that provided acceptable equivalent efficacy and patient satisfaction scores to ondansetron, 100 µg/kg IV, for the prophylaxis of postoperative vomiting in children undergoing outpatient surgery. However, with this dose, the costs to the institution for managing postoperative vomiting were less.

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999