DOCUMENT CONTROL PAGE Title Title: Guidelines for the management of postoperative nausea and vomiting in Children Version: 2 Reference Number: MMC-G40 Supersedes Supersedes: 1 Significant Changes: Revision to include recommendations by APAGBI 2008 Guidelines on Prevention of postoperative vomiting in children. 1) Putting the guideline into a flowchart for ease of use and understanding 2) Moving cyclizine from second line to third line agent. 3) Highlighting maximal doses of ondansetron 4) Introduction of dexamethasone as second line agent (adjunct) Circulation Application Ratification Originator or modifier Originated By: (1) Dr. R Walker, (2) D. Jonas, (3) A. Adams Designation: (1) Consultant Paediatric Anaesthetist and Lead Clinician Pain Management, (2)Lecturer/practitioner, (3)Principal pharmacist Modified by: (1)Dr. D. Patel, (2) D. Lowthian, (3) A. Sutherland Designation: (1) Consultant Paediatric Anaesthetist and Lead Clinician Pain Management, (2) Lead Practitioner Pain Management, (3) Senior Clinical Pharmacist Approved by: Medicines Management Committee & Children’s Pain Team Sub Committee Approval Date: May 2011 Patients – Children only Issue Date: July 2011 Circulated by: Children’s Pain Team Dissemination to (for Implementation): All Departments and All Medical staff RMCH Paediatric Pain Team Guideline Page 1 of 4 Guidelines for the management of Version Number: 2 (July 2011) postoperative nausea and vomiting Review Review Date: July 2014 Responsibility of: Children’s Pain Team Date placed on the Intranet: Please enter your EqIA Registration Number here: August 2011 216/11 Refer to section 5: Equality, Diversity and Human Rights Impact Assessment Section 1 2 3 4 Contents Detail of Procedural Document Equality, Diversity and Human Rights Impact Assessment Consultation, Approval and Ratification Process References and Bibliography Page 3 4 RMCH Paediatric Pain Team Guideline Page 2 of 4 Guidelines for the management of Version Number: 2 (July 2011) postoperative nausea and vomiting 4 4 Treatment Prophylaxis Age 3 years and over undergoing Emetogenic Surgery NO Previous PONV YES YES Vomiting 2 or more episodes (any age) YES Ondansetron up to 100micrograms/kg To be given at induction (Maximum dose 4mg/IV) Already received Ondansetron in last 8 hours NO NO No Anti-Emetic YES Dexamethasone up to 150 micrograms/kg NO Consider single dose of Dexamethasone up to 150 micrograms/kg No Anti-Emetic Persistent PONV after 2 different anti-emetics Ondansetron up to 200micrograms/kg (Maximum dose 8mg/IV) YES Persistent PONV after increase of Ondansetron Notes 1. Emetogenic Surgery is one of the following: Tonsillectomy, Middle Ear Surgery, Prominent Ear Correction, Strabismus Surgery, Procedures requiring Opioid Infusion or PCA, Long Procedures (Longer than 30 minutes). 2. Single episodes of vomiting do not require treatment but persistent nausea does require treatment. 3. Review patient regulary if anti-emetics required. 4. Any concerns about post-operative nausea and vomiting should be passed to the paediatric anaesthetic registrar on-call. YES Cyclizine 0.5 – 1mg/kg maximum dose 50 mg IV injection give slowly 3-5 minutes Call Paediatric Anaesthetist on call RMCH Paediatric Pain Team Guideline Page 3 of 4 Guidelines for the management of Version Number: 2 (July 2011) postoperative nausea and vomiting YES Persistent PONV After cyclizine given 2. Equality, Diversity and Human Rights Impact Assessment. 2.1 This protocol has had an initial assessment completed and a unique EqIA Registration Number assigned (see document control sheet). 3. 3.1 Consultation, Approval and Ratification Process Consultation Process, Consultation and Communication with Stakeholders This reviewed guideline has involved Consultant Anaesthetists, Children’s Pain Team and Pharmacy Policy Approval Process 3.2 Children’s Pain Team 3.3 Ratification Process Children’s Medicines Management Committee 4. References and Bibliography Revision to include recommendations by APAGBI 2008 - Guidelines on Prevention of postoperative vomiting in children. RMCH Paediatric Pain Team Guideline Page 4 of 4 Guidelines for the management of Version Number: 2 (July 2011) postoperative nausea and vomiting