{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T06:10:05Z","timestamp":1754028605273,"version":"3.41.2"},"reference-count":24,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Postoperative nausea and vomiting (PONV) remain significant complications following pediatric adenotonsillectomy. Although palonosetron, a second-generation 5-HT<jats:sub>3<\/jats:sub> receptor antagonist, has shown potential for preventing PONV, further research is needed to assess its efficacy when combined with dexamethasone in pediatric otolaryngologic procedures. This study aims to observe the efficacy of palonosetron or tropisetron combined with dexamethasone in preventing PONV in children undergoing adenotonsillectomy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We enrolled 110 children scheduled for elective adenotonsillectomy under general anesthesia. Based on a computer-generated random number table, children were assigned in equal proportions to receive either palonosetron or tropisetron. The P-group received palonosetron (1\u202f\u03bcg\/kg, maximum 50\u202f\u03bcg), while the T-group received tropisetron (0.1\u202fmg\/kg, maximum 2\u202fmg) 5\u202fmin before anesthesia induction. After receiving their allocated drug, children received intravenous dexamethasone (0.15\u202fmg\/kg, maximum 5\u202fmg) during induction. Primary outcomes included PONV incidence at 6, 24, and 48\u202fh postoperatively. Secondary outcomes included the number of children with PONV scores of 1, 2, and 3, rescue antiemetic medication, and adverse events.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 110 children (aged 3\u201312 y, ASA physical status 1 or 2, weighted 14.3\u201347.3\u202fkg) were enrolled in the study between December 2021 and July 2023. The P-group (<jats:italic>n<\/jats:italic>\u202f=\u202f52) demonstrated significantly lower PONV incidence than the T-group (<jats:italic>n<\/jats:italic>\u202f=\u202f51) during the 0\u201348\u202fh (5.8% vs. 25.5%, <jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.05). Notably, this difference was most pronounced during the first 24\u202fh: 0\u20136\u202fh (0% vs. 10%, <jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.05) and 6\u201324\u202fh (3.8% vs. 7.8%, <jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.05). The difference during 24\u201348\u202fh was insignificant (4% vs. 8%, <jats:italic>p<\/jats:italic>\u202f&amp;gt;\u202f0.05). Transient junctional rhythm occurred in three patients receiving tropisetron, which did not affect circulation. Headache and dizziness were similar between groups within 48\u202fh (P-group: 3.8%, T-group: 7.8%, <jats:italic>p<\/jats:italic>\u202f&amp;gt;\u202f0.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In pediatric adenotonsillectomy, palonosetron with dexamethasone gives better PONV prevention than tropisetron with dexamethasone, especially in the first 24\u202fh, with comparable safety.<\/jats:p><\/jats:sec><jats:sec><jats:title>Clinical trial registration<\/jats:title><jats:p><jats:uri>https:\/\/www.chictr.org.cn\/showproj.html?proj=127115<\/jats:uri>, ChiCTR2100046848.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2025.1549619","type":"journal-article","created":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T05:33:05Z","timestamp":1754026385000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Palonosetron versus tropisetron with dexamethasone for prevention of postoperative nausea and vomiting in pediatric adenotonsillectomy: a single center, randomized controlled trial"],"prefix":"10.3389","volume":"12","author":[{"given":"Hualin","family":"Chen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liping","family":"Sun","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jijian","family":"Zheng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hongbin","family":"Gu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,8,1]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1046\/j.1460-9592.2000.00401.x","article-title":"Tropisetron reduces postoperative vomiting in children undergoing tonsillectomy","volume":"10","author":"Jensen","year":"2000","journal-title":"Paediatr Anaesth"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"E1351","DOI":"10.59958\/hsf.7859","article-title":"The effectiveness and application of transcutaneous electrical Acupoint stimulation in the prevention of postoperative nausea and vomiting","volume":"27","author":"Yang","year":"2024","journal-title":"Heart Surgery Forum"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1213\/ANE.0000000000004833","article-title":"Fourth consensus guidelines for the management of postoperative nausea and vomiting","volume":"131","author":"Gan","year":"2020","journal-title":"Anesth Analg"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1007\/s00540-007-0523-0","article-title":"Prevention of postoperative nausea and vomiting in children following adenotonsillectomy using tropisetron with or without low-dose dexamethasone","volume":"21","author":"Liechti","year":"2007","journal-title":"J Anesth"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1125","DOI":"10.2165\/00003495-200464100-00006","article-title":"palonosetron","volume":"64","author":"Siddiqui","year":"2004","journal-title":"Drugs"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"29","DOI":"10.2165\/11586940-000000000-00000","article-title":"Different doses of palonosetron for the prevention of postoperative nausea and vomiting in children undergoing strabismus surgery","volume":"11","author":"Bicer","year":"2011","journal-title":"Drugs R D"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"918","DOI":"10.1093\/bja\/aex099","article-title":"Addition of droperidol to prophylactic ondansetron and dexamethasone in children at high risk for postoperative vomiting. 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Anesth"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"322","DOI":"10.4103\/aer.AER_183_17","article-title":"Comparison of Palonosetron, dexamethasone, and Palonosetron plus dexamethasone as prophylactic antiemetic and antipruritic drug in patients receiving intrathecal morphine for lower segment cesarean section","volume":"12","author":"Swaro","year":"2018","journal-title":"Anesth Essays Res"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"4","DOI":"10.4103\/ijciis.ijciis_150_20","article-title":"A comparison of prophylactic antiemetic therapy with palonosetron and dexamethasone as single-agents or in combination in adult patients undergoing laparoscopic surgery: a randomized trial","volume":"13","author":"Sadhoo","year":"2023","journal-title":"Int J Crit Illn Inj Sci"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1659","DOI":"10.3889\/oamjms.2018.366","article-title":"Investigation of ondansetron, haloperidol, and dexmedetomidine efficacy for 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Opin"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1097\/EJA.0000000000000932","article-title":"Use of Palonosetron and ondansetron in the prophylaxis of postoperative nausea and vomiting in women 60 years of age or older undergoing laparoscopic cholecystectomy: a randomised double-blind study","volume":"36","author":"Carvalho Braga","year":"2019","journal-title":"Eur J Anaesthesiol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1407","DOI":"10.1517\/14740338.2014.954546","article-title":"5-hydroxytryptamine3 receptor antagonists and cardiac side effects","volume":"13","author":"Brygger","year":"2014","journal-title":"Expert Opin Drug Saf"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"977","DOI":"10.1213\/ANE.0000000000001511","article-title":"Prevention of spinal anesthesia-induced hypotension during cesarean delivery by 5-Hydroxytryptamine-3 receptor antagonists: a systematic review and meta-analysis and meta-regression","volume":"123","author":"Heesen","year":"2016","journal-title":"Anesth Analg"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3389\/fmed.2016.00001","article-title":"The effect of a combination treatment using palonosetron, promethazine, and dexamethasone on the prophylaxis of postoperative nausea and vomiting and QTc interval duration in patients undergoing craniotomy under general anesthesia: a pilot study","volume":"3","author":"Bergese","year":"2016","journal-title":"Front Med"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"460","DOI":"10.1093\/bja\/aet335","article-title":"Effect of palonosetron on the QTc interval in patients undergoing sevoflurane anaesthesia","volume":"112","author":"Kim","year":"2014","journal-title":"Br J Anaesth"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"182","DOI":"10.4103\/joacp.JOACP_196_17","article-title":"A randomized study to compare palonosetron with ondansetron for prevention 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