PONV: Prevention in children


The 5-HT3 antagonist, of which Ondansetron is the best studied (and most efficacious) are currently the best known prophylactic treatment for POV in children (NNT 2/3 for early/late POV respectively).  Both the oral and IV forms are effective.  The optimal dose is 0.1 – 0.15 mg/kg.   

Droperidol is also effective with a NNT of about 5.  The optimal dose appears to be 50 – 70 mcg/kg, however, this dose is exceptionally high in children.  The actual recommended dose is 10 – 15 mcg/kg for POV prevention.

Combination therapy has proven to be more effective than monotherapy, especially in moderate to high risk children.  The current recommendations are to give prophylactic doses of Ondansetron and Dexamethasone to all children at moderate to increased risk of POV unless contraindicated.

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