Comparison of the effects of low dose methylprednisolone and metoclopramide on nausea and vomiting and respiratory complications after adenotonsillectomy in children

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Kepekci A. B., Subasi B., Kepekci A. H., Yarbil A.

Anaesthesia, Pain and Intensive Care, vol.24, no.5, pp.544-551, 2020 (ESCI) identifier

  • Publication Type: Article / Article
  • Volume: 24 Issue: 5
  • Publication Date: 2020
  • Doi Number: 10.35975/apic.v24i5.1360
  • Journal Name: Anaesthesia, Pain and Intensive Care
  • Journal Indexes: Emerging Sources Citation Index (ESCI), Scopus, Academic Search Premier, EMBASE
  • Page Numbers: pp.544-551
  • Kütahya Health Sciences University Affiliated: Yes


© 2020 Faculty of Anaesthesia, Pain and Intensive Care, AFMS. All rights reserved.Aim: Since tonsillectomies and/or adenoidectomies performed in the pediatric age group under general anesthesia have a high rate of postoperative nausea and vomiting (PONV), the practice of using prophylactic antiemetic drugs is common. This study aimed to compare the benefits of systemic administration of a low dose of inj. methylprednisolone 1 mg/kg with inj. metoclopramide 0.15 mg/kg IV for the prevention of PONV in children undergoing adenotonsillectomy. Methodology: In this study, the files of children undergone adenotonsillectomy from August 2015 to January 2018 in our hospital were analyzed retrospectively. 408 children aged 4-12 years were included in the study. Patients who were given methylprednisolone 1 mg/kg IV as premedication were placed in Group P, and patients who received metoclopramide 0.15 mg/kg were grouped as Group M. Effects on PONV, vomiting episodes, oral intake time, postoperative analgesic requirement, postoperative respiratory complications, and drug side effects were recorded. Results: Vomiting rates between 1-4 hrs (late period) were 11.0% in Group M (n = 22); It was 3.8% (n = 8) in Group P. In the late period, a significant difference was found between the two groups in terms of nausea and vomiting (p = 0.02, p = 0.07, respectively). In Group M, the incidence of respiratory complications was also higher in the postoperative period compared to Group P. Postoperative acetaminophen requirement increased significantly in group M compared to Group P (p = 0.006). Conclusion: Prophylactic use of a single dose of methylprednisolone 1 mg/kg IV during the preoperative period was more effective in reducing the incidence of late postoperative vomiting compared to metoclopramide and led to earlier tolerance of oral intake. In addition to its anti-inflammatory properties and antiemetic effects, low-dose methylprednisolone is also useful for prevention of respiratory complications.