Bademcik Ameliyatı Sonrası Kusma Önleyici Yaklaşımların Tedavi İçin Gereken Kişi TG Yöntemi ile Değerlendirilmesi

Öz

Amaç: Bademcik alınma ameliyatından sonra kusma ve mide bulantısını önlemek için birçok farklı yaklaşım vardır. Bu araştırmada, çocuklarda bademcik ameliyatından sonra mide bulantısıyla ilgili olarak yapılmış çalışmalara ait sonuçlardan yararlanarak ameliyat sonrası mide bulantısını önleyebilmek ve uygun sonuçlara ulaşabilmek için odds ratio OR , atfedilen risk attributable risk yani AR ve number needed to treat NNT metodları uygulandı. Yöntem: Çalışmada, rastgele kontollü deney düzeninde tasarlanmış RCT 15 çalışmaya ait sonuçlar OR, AR ve NNT ile değerlendirildi. Bulgular: Kusmayı önlemek için Acetaminophene göre Diclofenoc, tropisetron + dexamethasone’a göre tropisetron, perphenazinee göre granisetron, droperidol ve normal saline daha iyi bulunmuştur. Ayrıca, yine kusmayı önlemek için 1.2 mg ondansetron plus 1.1 mg dexanethasone normal saline göre ve metaclopramide ondansetrona göre daha etkisiz bulunmuştur. Sonuç: Bu bulgulara göre tonsillektomi sonrası antiemetik kullanılmasının önemli olduğu gözlendi.

Anahtar Kelimeler

• Bademcik ameliyatı,kusma,odds ratio,atfedilen risk,number neened to treat

Evaluation of Prophylactic Approaches Against Vomiting After Tonsillectomy Using Number Needed to Treat Method

Öz

Objective s : Many different approaches are available to prevent, vomiting and nausea after tonsillectomy. In this research, study team has benefited from the results of the studies performed to prevent vomiting after paediatric tonsillectomy utilizing odds ratio OR , attributable risk AR and also number needed- to treat NNT methods. Methods: In this study, results of 15 randomized controlled trials RCT were evaluated using OR, AR and NNT. Results: For the prevention of vomiting diclofenac, tropisetron, and granisetron, droperidol and normal saline were found to be more effective than acetaminophen, tropisetron plus dexamethasone, respectively, perphenazine. Also, 1.2 mg ondansetron plus 1.1 mg dexanethasone was detected to be less effective than than normal saline and metaclopramide. Conclusion: According to these findings, the use of antiemetics after tonsillectomy was observedly important.

Anahtar Kelimeler

• Tonsillectomy,vomiting,odds ratio,attributable risk,number needed to treat

Kaynakça

1. Karlsson E, Larsson LE, Nilsson K. Postanaesthetic nausea in children. Acta Anaesthesiol Scand 1990;34(7):515-8. http://dx.doi.org/10.1111/j.1399-6576.1990.tb03136.x PMid:1978765
2. Watcha MF, White PF. Postoperative nausea and vomiting. Its etiology, treatment, and prevention. Anesthesiology 1992;77(1):162-84. http://dx.doi.org/10.1097/00000542-199207000-00023 PMid:1609990
3. Watcha MF, White PF. Post-operative nausea and vomiting: do they matter? Eur J Anaesthesiol Suppl 1995;10:18-23. PMid:7641638
4. Tramèr M, Moore A, McQuay H. Prevention of vomiting after paediatric strabismus surgery: a systematic review using the numbers-needed-to-treat method. Br J Anaesth 1996;76(3):473-4.
5. Bolton CM, Myles PS, Nolan T, Sterne JA. Prophylaxis of postoperative vomiting in children undergoing tonsillectomy: a systematic review and meta-analysis. Br J Anaesth 2006;97(5):593-604. Epub 2006 Sep 26. http://dx.doi.org/10.1093/bja/ael256 PMid:17005507
6. Bennett AM, Emery PJ. A significant reduction in paediatric post-tonsillectomy vomiting through audit. Ann R Coll Surg Engl 2008;90(3):226-30. http://dx.doi.org/10.1308/003588408X261591 PMid:18430338 PMCid:2430462
7. Chen YQ, Hu C, Wang Y. Attributable risk function in the proportional hazards model for censored time-to-event. Biostatistics 2006;7(4):515-29. http://dx.doi.org/10.1093/biostatistics/kxj023 PMid:16478758
8. Altman DG. Confidence intervals for the number needed to treat. BMJ 1998;317(7):1309-12. http://dx.doi.org/10.1136/bmj.317.7168.1309 PMid:9804726 PMCid:1114210

9. Celiker V, Celebi N, Canbay O, Başgül E, Aypar U. Minimum effective dose of dexamethasone after tonsillec- tomy. Paediatr Anaesth 2004;14(8):666-9. http://dx.doi.org/10.1111/j.1460-9592.2004.01262.x PMid:15283826
10. Kearney R, Mack C, Entwistle L. Withholding oral fluids from children undergoing day surgery reduces vomiting. Paediatr Anaesth 1998;8(4):331-6. http://dx.doi.org/10.1046/j.1460-9592.1998.00269.x PMid:9672932
11. Picard V, Dumont L, Pellegrini M. Quality of recovery in children: sevoflurane versus propofol. Acta Anaesthesiol Scand 2000;44(3):307-10. http://dx.doi.org/10.1034/j.1399-6576.2000.440315.x PMid:10714845
12. Rİmsing J, Ostergaard D, Drozdziewicz D, Schultz P, Ravn G. Diclofenac or acetaminophen for analgesia in paedi- atric tonsillectomy outpatients. Acta Anaesthesiol Scand 2000;44(3):291-5. http://dx.doi.org/10.1034/j.1399-6576.2000.440312.x PMid:10714842
13. Morton NS, Camu F, Dorman T, Knudsen KE, Kvalsvik O, Nellgard P, et al. Ondansetron reduces nausea and vomi- ting after paediatric adenotonsillectomy. Paediatr Anaesth 1997;7(1):37-45. http://dx.doi.org/10.1046/j.1460-9592.1997.d01-39.x PMid:9041573
14. Gross D, Reuss S, Dillier CM, Gerber AC, Weiss M. Early vs late intraoperative administration of tropisetron for the prevention of nausea and vomiting in children undergoing tonsillectomy and/or adenoidectomy. Paediatr Anaesth 2006;16(4):444-50. http://dx.doi.org/10.1111/j.1460-9592.2005.01780.x PMid:16618300
15. Fujii Y, Saitoh Y, Tanaka H, Toyooka H. Anti-emetic effi- cacy of prophylactic granisetron compared with perphenazine for the prevention of post-operative vomiting in children. Eur J Anaesthesiol 1999;16(5):304-7. PMid:10390665
16. Fujii Y, Saitoh Y, Tanaka H, Toyooka H. Comparison of granisetron and droperidol in the prevention of vomiting after strabismus surgery or tonsillectomy in children. Paediatr Anaesth 1998;8(3):241-4. http://dx.doi.org/10.1046/j.1460-9592.1998.00206.x PMid:9608970
17. Mendham JE, Mather SJ. Comparison of diclofenac and tenoxicam for postoperative analgesia with and without fen- tanyl in children undergoing adenotonsillectomy or tonsillec- tomy. Paediatr Anaesth 1996;6(6):467-73. http://dx.doi.org/10.1046/j.1460-9592.1996.d01-22.x PMid:8936545
18. Fujii Y, Saitoh Y, Tanaka H, Toyooka H. Prevention of pos- toperative vomiting with granisetron in paediatric patients with and without a history of motion sickness. Paediatr Anaesth 1999;9(6):527-30. Comment in: Paediatr Anaesth 2000;10(4):451-2. http://dx.doi.org/10.1046/j.1460-9592.1999.00414.x PMid:10597557
19. Holt R, Rask P, Coulthard KP, Sinclair M, Roberts G, Van Der Walt J, et al. Tropisetron plus dexamethasone is more effective than tropisetron alone for the prevention of postope- rative nausea and vomiting in children undergoing tonsillec- tomy. Paediatr Anaesth 2000;10(2):181-8. http://dx.doi.org/10.1046/j.1460-9592.2000.00475.x PMid:10736082
20. Bolton CM, Myles PS, Carlin JB, Nolan T. Randomized, double-blind study comparing the efficacy of moderate-dose metoclopramide and ondansetron for the prophylactic control of postoperative vomiting in children after tonsillectomy. Br J Anaesth 2007;99(5):699-703. http://dx.doi.org/10.1093/bja/aem236 PMid:17715139
21. Guler G, Akin A, Tosun Z, Ors S, Esmaoglu A, Boyaci A. Single-dose dexmedetomidine reduces agitation and provides smooth extubation after pediatric adenotonsillectomy. Paediatr Anaesth 2005;15(9):762-6. http://dx.doi.org/10.1111/j.1460-9592.2004.01541.x PMid:16101707
22. Bergendahl HT, Lönnqvist PA, Eksborg S, Ruthström E, Nordenberg L, Zetterqvist H, Oddby E. Clonidine vs. mida- zolam as premedication in children undergoing adeno- tonsillectomy: a prospective, randomized, controlled clinical trial. Acta Anaesthesiol Scand 2004;48(10):1292-300. http://dx.doi.org/10.1111/j.1399-6576.2004.00525.x PMid:15504191
23. Howell TK, Smith S, Rushman SC, Walker RW, Radivan F. A comparison of oral transmucosal fentanyl and oral mida- zolam for premedication in children. Anaesthesia 2002;57(8):798-805. http://dx.doi.org/10.1046/j.1365-2044.2002.02698_4.x
24. Şenocak MŞ. Klinik Biyoistatistik. Nobel Tıp Kitabevleri Ltd. Şti, 2009.