So sánh hiệu quả dự phòng nôn và buồn nôn sau phẫu thuật nội soi ổ bụng cấp cứu ở trẻ em của ondansetron kết hợp Dexamethasone với Ondansetron đơn thuần

Postoperative nausea and vomiting (PONV) remains a critical concern in pediatric anesthesiology, particularly following emergency laparoscopic surgery. Its high incidence in children (up to 70-80% in high-risk cases) not only causes significant distress but also prolongs recovery, increases hospital stay, and can lead to serious complications such as aspiration, dehydration, and electrolyte imbalance. While single antiemetic agents like Ondansetron are commonly used, their efficacy, especially in high-risk pediatric patients, may not be sufficient. The integration of multi-modal antiemetic strategies, particularly combining different drug classes, is increasingly advocated. This study aims to compare the effectiveness of Dexamethasone combined with Ondansetron against Ondansetron alone in preventing vomiting and nausea after emergency laparoscopic surgery in children. The findings will contribute to optimizing prophylactic protocols for this vulnerable patient population.

Anesthesiologists, pediatric surgeons, pediatricians, and healthcare professionals involved in the perioperative care of children undergoing laparoscopic surgery.

Postoperative nausea and vomiting (PONV) poses a significant challenge in pediatric care, particularly after emergency laparoscopic surgery in children, with incidence rates potentially reaching 70-80% in high-risk groups. Beyond discomfort, PONV can lead to serious medical complications and extended hospital stays. Current guidelines often suggest multi-modal approaches to enhance prophylaxis. This study investigated two common antiemetic strategies: Ondansetron alone versus Dexamethasone combined with Ondansetron. A prospective, controlled clinical trial was conducted on children aged 3 to 12 years undergoing emergency laparoscopic surgery. Participants were divided into two groups: Group I received prophylaxis with Dexamethasone combined with Ondansetron, while Group II received Ondansetron alone. The primary outcomes measured included the incidence of vomiting and nausea and the occurrence of side effects within 24 hours post-surgery, with evaluation particularly focused on patients with two or more PONV risk factors according to the Eberhart scale. The study found that the combination of Dexamethasone (0.15 mg/kg) and Ondansetron (0.1 mg/kg) significantly reduced the rate of postoperative nausea and vomiting by 13.5% compared to Ondansetron alone (0.1 mg/kg). Specifically, the incidence of PONV in patients with two or more risk factors was lower in the combination group. Side effects such as itching, headache, and dizziness were monitored. The combination group reported itching at 2.3%, headache at 4.5%, and dizziness at 4.5%, while the Ondansetron alone group showed similar rates for itching (2.3%) and headache (4.5%) but a higher rate for dizziness (6.8%). Overall, the combination therapy demonstrated superior efficacy without a significant increase in adverse events. The results strongly suggest that the combined use of Dexamethasone and Ondansetron is a more effective and safe strategy for preventing PONV in high-risk pediatric patients undergoing emergency laparoscopic surgery. This dual-agent approach offers prolonged antiemetic protection, reducing patient distress, minimizing recovery time, and potentially mitigating post-operative complications, thereby improving the quality of care for children.