Prophylactic treatment for postoperative nausea and vomiting in children undergoing ambulatory surgery

Postoperative nausea and vomiting (PONV) continues to be a serious complication in children after surgery and the PONV-rate can be as high as 70% in high-risk patients without prophylaxis. The aim of this interventional study is a head-to-head comparison of various anti-emetic drugs that may help to develop a systematic review of pharmacological alternatives for PONV in children. The patients will be stratified based on the amount of risk factors and they will be randomly assigned to a treatment with dexamethasone alone, dexamethasone + a bolus of proposal or dexamethassone + ondansetron. Our primary outcomes are nausea and vomiting. Our secondary outcomes are pain and agitation. Rebleeding and other complications will be carefully monitored.

- The incidence of PONV will be higher in the group receiving dexamethasone alone

- There will be no significant difference in the incidence of PONV between the two groups receiving two anti-emetic drugs

- There will be less postoperative agitation in the group receiving propofol

- 30 minutes after the surgery

- 2 hours after the surgery

- 24 hours after the surgery

The patients will be stratified into three groups based on the amount of risk factors for PONV. Then they will be randomly assigned to one of the three treatments:

1. Dexamethasone + placebo

2. Dexamethasone + a bolus of propofol

3. Dexamethasone + ondansetron