Revisiting the applicability of adult early post-operative nausea and vomiting risk factors for the paediatric patient: A prospective study using cotinine levels in children undergoing adenotonsillectomies.

BACKGROUND AND AIMS: Post-operative vomiting (POV) in children remains a significant clinical problem. This prospective study aims to investigate the applicability of well-established adult early post-operative nausea and vomiting (PONV) risk factors on paediatric POV after adenotonsillectomies under regulated anaesthetic conditions. METHODS: After Institutional Review Board approval, 213 children aged 3-10-year-old were enrolled. The participants had pre-operative questionnaires completed, followed protocolised anaesthetic plans and had saliva analysed for cotinine. The primary outcomes were POV as correlated with age, gender, family or personal history of PONV, motion sickness history, opioid use, surgical time, anaesthetic time and environmental tobacco smoke (ETS) exposure, as assessed by cotinine levels and questionnaire reports. Data on analgesics, antiemetics and POV incidence before post-anaesthesia care unit discharge were collected. Statistical analysis was done through multiple logistic regression. RESULTS: A total of 200 patients finalised the study. Early POV occurred in 32%. Family history of PONV (odds ratio [OR] = 5.3, P < 0.01) and motion sickness history (OR = 4.4, P = 0.02) were highly significant risk factors. Age reached borderline statistical significance (OR = 1.4, P = 0.05). None of the other factors reached statistical significance. CONCLUSION: Early POV occurs frequently in paediatric patients undergoing adenotonsillectomies. In this paediatric-aged group, the incidence of POV was affected by the family history of PONV, and history of motion sickness. Age, female gender, opioid use, surgical and anaesthetic times did not affect the incidence of POV. ETS exposure, as assessed by cotinine levels and questionnaire reports, had no protective effect on early paediatric POV.

Transesophageal echocardiography monitoring in the delivery of a preeclamptic parturient with severe left ventricular noncompaction.

A multidisciplinary approach to the preterm delivery of a preeclamptic parturient with severe left ventricular (LV) noncompaction and pulmonary hypertension using transesophageal echocardiography (TEE) as a monitor of hemodynamic status in lieu of a pulmonary artery catheter during general anesthesia for Cesarean section is presented. This case adds to the available literature on LV noncompaction with pulmonary hypertension in preeclamptic parturients, and addresses the anesthetic concerns and approaches to management using echocardiography in these highly complex patients.