Release: May 12, 2000
Contact: Kenneth Satterfield, 407-238-4161 (as of 5/12/2000)
GASTRIC ASPIRATION FAILS TO REDUCE POST-TONSILLECTOMY VOMITING IN CHILDREN
Orlando, FL -- Post-operative vomiting represents the most common complication of pediatric tonsillectomy and adenoidectomy. Despite advances in anesthetic and surgical technique, incidences as high as 75 percent have been reported. Persistent vomiting is costly both in terms of financial impact and potential medical problems. Many in the medical community believe that patient characteristics, anesthetic medications, surgical manipulation, and post-operative care all contribute to this problem.
Multiple studies have investigated the effects of newer anesthetic agents and anti-vomiting preventive measures. In general, the results of these studies have been mixed. Marginal improvements, unfavorable side effect profiles and high costs have limited the universal adoption of any single protocol.
One such measure is gastric aspiration, used to reduce post-operative vomiting and advocated in the older medical literature. However, recent studies have failed to demonstrate any benefit of gastric aspiration in reducing post-operative vomiting in gynecologic or general surgical patients. Furthermore, a recent literature search failed to find any prospective studies examining the effectiveness of gastric aspiration in reducing post-operative vomiting following tonsillectomy and adenoidectomy.
Accordingly, a research study was conducted to determine the efficacy of gastric aspiration in reducing the incidence and complications associated with post-tonsillectomy vomiting in children. The authors of the study, "The Efficacy of Gastric Aspiration in Reducing Post-tonsillectomy Vomiting,"
are from the Weill College of Medicine at Cornell University, New York, NY. Jacqueline E. Jones, MD, Robert Glasgold, MD, and Abtin Tabaee are from the Department of Otorhinolaryngology;
Mathew C. Gomillion, MD, is from the Department of Anesthesiology. Their findings were presented to a joint meeting of the Triological Society and the American Society of Pediatric Otolaryngology, meeting May 16-18, in Orlando, FL.
Methodology: Eighty pediatric patients who underwent tonsillectomy with or without adenoidectomy at a New York Hospital between July, 1997, and November, 1999, were included in the study. Patients were alternately randomized to the control group or the study group at the time of enrollment. Patients in the study group underwent gastric aspiration with an orogastric tube prior to extubation following the surgery. Those in the control group did not undergo gastric aspiration. Patients with any significant history of gastrointestinal disorders were ineligible for the study.
The 39 patients comprising the study group underwent post-operative aspiration of gastric contents with an orogastric tube placed under direct visualization while still under general anesthesia. The 35 patients comprising the control group did not undergo gastric aspiration following surgery.
The anesthetic protocol was standardized throughout the study, and all procedures were supervised by the same anesthesiologist. Inhalational anesthesia was achieved with 2 percent sevoflurane delivered in 30 percent oxygen and 70 percent nitrous oxide. Intravenous morphine (0.1 mg/kg) was administered at the time of induction. Intravenous mivacurium (0.25 mg/kg) was used for muscle paralysis to facilitate intubation. Intra-operative steroids and antibiotics were not used.
The surgical technique was standardized, and all procedures were supervised by the same pediatric otolaryngologist. Tonsillectomy was performed using electrocautery, and hemostasis was obtained by packing the tonsillar fossa followed by suction electrocautery. Adenoidectomy was performed using adenoid curettes and Sinclair forceps. Hemostasis was obtained with nasopharyngeal packing followed by suction electrocautery.
Data on the number of episodes of vomiting, total volume of emesis, post-operative length of stay, administration of rescue anti-emetics and re-admission to the hospital for persistent vomiting was collected from the hospital chart, parents' logs and follow up telephone calls by the research team.
Results: Ten patients were excluded from the final analysis, five due to failure of the parents to complete and return the data forms and one due to post-operative bleeding. Of the 74 patients included in the study, 35 were in the control group and 39 were in the study group. The 39 patients comprising the study group underwent post-operative aspiration of gastric contents with an orogastric tube placed under direct visualization while still under general anesthesia. The 35 patients comprising the control group did not undergo gastric aspiration following surgery. Examined were the incidence of vomiting, the number of episodes of vomiting pre and post-discharge, total volume of emesis, post-operative length of stay, need for rescue anti-emetics and number of readmissions to the hospital for persistent vomiting.
There was no significant difference (p < 0.05) between the control group (no gastric aspiration following surgery) and the study group (aspiration performed in terms of patient vomiting (74 percent vs. 85 percent), mean number of episodes of vomiting pre-discharge (2.6 vs. 2.8), mean number of episodes of vomiting post-discharge (0.8 vs. 0.7), mean volume of emesis (157 cc vs. 222 cc), post-operative length of stay (394 minutes vs. 334 minutes), percent of patients requiring rescue anti-emetics (34 percent vs. 33 percent) and percent of unplanned admissions due to vomiting (9 percent vs. 15 percent).
Conclusions: The data does not support the routine use of orogastric tube placement for gastric aspiration following pediatric tonsillectomy. There was no reduction in the incidence of post-operative vomiting, number of episodes of vomiting, post-operative length of stay or unplanned admissions. The results are consistent with the results of previous studies in other surgical fields. Therefore, the routine use of gastric aspiration requires reassessment. Further studies are needed to evaluate the role of gastric aspiration in select cases where significant bleeding or gastric distention is a concern.
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