To the Editor:—Furst and Rodarte [1] recently reported that 0.15 mg/kg intravenous ondansetron is highly effective in reducing post-tonsillectomy vomiting in children and that droperidol and metoclopramide are not effective. These data are significant because droperidol and metoclopramide have been reported to be effective prophylactic antiemetics in children. [2,3] However, contrary to the authors' introductory statement that “no studies to date have examined the use of ondansetron in children for the prevention of postoperative emesis,” numerous clinical investigations and abstracts on this subject are published. [4–7] In one of these reports, 0.15 mg/kg intravenous ondansetron is reported to decrease vomiting after tonsillectomy in children from 73%(of the placebo group) to 23%(of the ondansetron group). [4].
In addition, we question a premise of their experimental design. Specifically, the authors state that the dose of metoclopramide used in their study (0.5 mg/kg intravenously) was “selected from the literature” and has been shown effective in preventing postoperative emesis in children at high risk for this complication. However, in none of the references to this claim has the use of this dose of metoclopramide been studied in healthy children undergoing surgery. The authors attempt to further justify this relatively large dose of metoclopramide by stating that doses as large as 3 mg/kg intravenously are used for the prevention of chemotherapy-induced vomiting. [8] The authors fail to mention that this dose of metoclopramide (3 mg/kg intravenously) was part of an antiemetic regimen that included 25–50 mg intravenous diphenhydramine, decadron, and lorazepam. In another article coauthored by Furst and Rodarte, they state a reluctance to use more than 0.25 mg/kg metoclopramide because of the potential for extrapyramidal side effects. [9] Has the safety and efficacy of 0.5 mg/kg intravenous metoclopramide in children during the perioperative period been established? If not, were parents of subjects in this study apprised of the experimental nature of this dose of metoclopramide?
John B. Rose, M.D., Thalia M. Martin, M.D., Department of Anesthesiology, Alfred L. duPont Institute of the Nemours Foundation, 1600 Rockland Road, P. O. Box 269, Wilmington, Delaware 19899.
(Accepted for publication February 10, 1995.)
