„Low-dose“-Droperidol-Gabe bei Kindern

Zusammenfassung

Hintergrund

Persistierende postoperative Übelkeit und Erbrechen („postoperative nausea and vomiting“, PONV) trotz Prophylaxe ist in der Kinderanästhesie ein wichtiges Problem. In der vorgestellten Studie wurde untersucht, ob die „Low-dose“-Droperidol-Gabe (10 µg/kgKG) als Rescue-Therapie bei persistierender PONV effektiv ist.

Patienten und Methoden

Im elektronischen Archiv der Anästhesieabteilung der Universitäts-Kinderkliniken Zürich wurden von 2004 bis 2009 alle Patienten herausgefiltert, die im Aufwachraum Droperidol erhalten hatten. Es wurde überprüft, ob Low-dose-Droperidol gegen persistierende PONV wirksam ist und ob unerwünschte Nebenwirkungen aufgetreten sind.

Ergebnisse

Daten von 144 Patienten im Alter von 12,3 Jahren [Interquartilabstand (IQR) 9,5 bis 15,2 Jahre] konnten für die Untersuchung verwendet werden. Bei 128 Patienten (89%) war die Rescue-Therapie mit Low-dose-Droperidol effektiv. Bei 16 Patienten (11%) erfolgte keine Besserung. Sedation war die einzige beobachtete Nebenwirkung bei 39 Patienten (27%).

Schlussfolgerung

Die Gabe von Low-dose-Droperidol erwies sich als effektive Rescue-Therapie bei Kindern, bei denen trotz prophylaktischer antiemetischer Therapie PONV persistierte.

Abstract

Background

Droperidol had been used as an effective antiemetic since the 1970s but was withdrawn from the market in 2001 because of a black box warning about QT prolongation and possible cardiac arrhythmia after high doses. In the meantime the black box warning has seriously been questioned and parenteral droperidol has again been licensed in 2008. Because droperidol acts on dopaminergic receptors different to 5-HT₃ antagonists and dexamethasone, it could possibly serve as a rescue drug after failed postoperative nausea and vomiting (PONV) prophylaxis. Persistent PONV after the recommended prophylaxis is a significant problem in pediatric anesthesia but a satisfactory strategy has not yet been defined. Therefore a retrospective audit was performed in order to evaluate whether low-dose droperidol (10 µg/kgBW) would be an effective rescue drug for failed antiemetic prophylaxis.

Patients and methods

The electronic anesthesia patient data base of the University Children’s Hospital Zurich was searched from 2004–2009 for patients who received low-dose droperidol in the postanesthesia care unit as rescue therapy for persistent PONV after antiemetic prophylaxis. Based on the recorded electronic data the effectiveness of low-dose droperidol as PONV rescue therapy and possible side effects were analyzed.

Results

A total of 338 patients who received droperidol were found from a total of 34,032 patients and the charts were analyzed. Of these patients 134 were excluded because they had received droperidol for indications other than PONV, 43 patients were excluded because they had not received antiemetic prophylaxis before droperidol and in 17 patients the data were incomplete, leaving 144 patients with an average age of 12.3 years (interquartile range IQR 9.5–15.2 years) for analysis. The upper range of ages resulted from patients with chronic diseases who were still being treated in the Children’s Hospital. Low-dose droperidol was given because of persistent nausea to 59 patients (41%) and to 85 patients (59%) for persistent vomiting. Initial antiemetic prophylaxis and/or therapy had consisted of dexamethasone plus tropisetrone in 80 patients and tropisetrone or dexamethasone alone in 64 patients. In 128 patients (89%) rescue therapy with a median dose of 10.9 µg/kgBW droperidol was effective but vomiting persisted in 16 patients (11%). Sedation was the only side effect recorded and this was observed in 39 patients (27%).

Conclusions

Low-dose droperidol (10 µg/kgBW) was found to be effective as rescue medication in pediatric patients experiencing PONV despite various prophylactic antiemetic regimens. No neurological or cardiopulmonary side effects were recorded after this low dosage.