Treatment of postoperative nausea and vomiting in children
Before starting antiemetic therapy for postoperative nausea and vomiting (PONV), ensure children are adequately hydrated, and check for hypoglycaemia and hypotension. All commonly used antiemetics can have significant adverse effects, particularly in children; consider relevant contraindications and precautions before prescribing.
For established PONV in children, treat with a drug from a different class to that used for prophylaxis. Options include:
ondansetron 0.1 mg/kg up to 4 mg intravenously ondansetron ondansetron ondansetron
OR
dexamethasone 0.15 mg/kg up to 4 mg intravenously dexamethasone dexamethasone dexamethasone
OR
droperidol (child older than 2 years) 0.01 to 0.02 mg/kg up to 0.625 mg intravenously1. droperidol droperidol droperidol
Repeat doses of ondansetron may be given if there is no suitable alternative and longer than 6 hours has elapsed since the previous dose. Re-administration of longer-acting drugs (eg dexamethasone) is not recommended. Metoclopramide has been used for treatment of PONV in children; however, serious adverse effects limit its use2Therapeutic Goods Administration, 2015. Promethazine or cyclizine may be used as an alternative for refractory PONV; seek expert advice from an acute pain service or anaesthetist.
If PONV continues, exclude surgical causes; expert advice may be required for ongoing management.