Prophylaxis for pediatric postoperative nausea and vomiting: a scoping review of clinical trials

PurposePostoperative nausea and vomiting (PONV) is common in pediatric patients undergoing general anesthesia, and clinicians seek prophylactic interventions to prevent its ill effects on patients as well as its ramifications on perioperative care. We sought to assess the body of evidence around prophylactic strategies, both pharmacologic and nonpharmacologic, targeting pediatric PONV.SourceWe searched MEDLINE, MEDLINE ePubs Ahead of Print and In-Process Citations, Embase Classic+Embase, the Cochrane Database of Systematic Reviews, Cochrane CENTRAL (via the Ovid platform), Scopus (Elsevier), Web of Science (Clarivate Analytics), ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform, and the International Standard Randomized Controlled Trial Number Registry, from their inception to 23 September 2022.Principal findingsOf 188 clinical trials, 157 (83%) investigated pharmacologic interventions, 25 (13%) investigated nonpharmacologic interventions, and six (3%) investigated mixed pharmacologic and nonpharmacologic interventions. The most common surgeries investigated for pediatric PONV were strabismus surgery (68 trials, 36%) and tonsillectomy or tympanoplasty (45 trials, 23%). Of four measurement tools used to assess PONV in the included trials, the most common was clinical judgement (170 trials, 90%).ConclusionThe majority of data in pediatric PONV prophylaxis is based on pharmacologic interventions, with a paucity of research in nonpharmacologic or mixed interventions. Assessing and documenting PONV using tools such as the Baxter Animated Retching Faces Scale or PONV numeric scoring system may help standardize pediatric PONV prophylaxis research moving forward. Furthermore, concurrently assessing pain and adverse effects associated with PONV might further inform our understanding of this complex clinical entity. ObjectifLes nausees et vomissements postoperatoires (NVPO) sont frequents chez la patientele pediatrique beneficiant d'une anesthesie generale, et les equipes cliniques recherchent des interventions prophylactiques pour prevenir leurs effets nefastes sur les patient center dot es ainsi que leurs ramifications sur les soins perioperatoires. Nous avons cherche a evaluer l'ensemble des donnees probantes entourant les strategies prophylactiques pharmacologiques et non pharmacologiques ciblant les NVPO pediatriques.SourcesNous avons effectue des recherches dans les bases de donnees MEDLINE, MEDLINE ePubs Ahead of Print and In-Process Citations, Embase Classic+Embase, la base de donnees des revues systematiques Cochrane, Cochrane CENTRAL (via la plateforme Ovid), Scopus (Elsevier), Web of Science (Clarivate Analytics), ClinicalTrials.gov, le systeme d'enregistrement international des essais cliniques de l'OMS et le registre international normalise des numeros d'essais controles randomises, depuis leur creation jusqu'au 23 septembre 2022.Constatations principalesSur 188 etudes cliniques, 157 (83 %) portaient sur des interventions pharmacologiques, 25 (13 %) sur des interventions non pharmacologiques et six (3 %) sur des interventions pharmacologiques et non pharmacologiques mixtes. Les chirurgies les plus frequemment etudiees pour les NVPO pediatriques etaient les chirurgies de strabisme (68 etudes, 36 %) et les amygdalectomies ou tympanoplasties (45 etudes, 23 %). Parmi les quatre outils de mesure utilises pour evaluer les NVPO dans les etudes incluses, le plus frequemment utilise etait le jugement clinique (170 etudes, 90 %).ConclusionLa majorite des donnees sur les prophylaxies pediatriques pour prevenir les NVPO sont basees sur des interventions pharmacologiques, avec peu de recherche sur les interventions non pharmacologiques ou mixtes. L'evaluation et la documentation des NVPO a l'aide d'outils tels que l'echelle Baxter Animated Retching Faces Scale ou un systeme de notation numerique des NVPO peuvent aider a normaliser la recherche sur la prophylaxie pediatrique des NVPO a l'avenir. De plus, l'evaluation simultanee de la douleur et des effets indesirables associes aux NVPO pourrait eclairer davantage notre comprehension de cette entite clinique complexe.

Automated summary

This study assessed the evidence for prophylactic strategies targeting pediatric postoperative nausea and vomiting (PONV) and found that most of the data is based on pharmacologic interventions, with limited research on nonpharmacologic or mixed interventions. The use of appropriate assessment tools can help standardize research on pediatric PONV prophylaxis, and concurrently evaluating pain and adverse effects associated with PONV may further inform our understanding of this complex clinical entity.