Vomiting after intrathecal chemotherapy under anesthesia in pediatric patients with hematologic cancers: A cohort study

Introduction Despite preventive strategies, vomiting is an adverse event affecting patients with cancer. However, literature on the incidence and risk factors for vomiting in pediatric patients with cancer are scarce. Aim To assess the incidence and risk factors for vomiting within 24 h and goodness...

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Published in:Pediatric anesthesia 2024-01, Vol.34 (1), p.51-59
Main Authors: França de Moraes, Gustavo Henrique, Lima, Luciana Cavalcanti, Couceiro, Tania Cursino de Menezes, Lins, Mecneide Mendes, Cumino, Débora de Oliveira, Simões, Leonardo Augusto Barbosa Magalhães, Mello, Maria Júlia Gonçalves de
Format: Article
Language:English
Subjects:
Anesthesia
Antiemetics - therapeutic use
Blood cancer
Chemotherapy
Child
Cohort analysis
Cohort Studies
Confidence intervals
Double-Blind Method
Female
Hematologic Neoplasms - drug therapy
Humans
Male
neoplasms
Neoplasms - drug therapy
Ondansetron - therapeutic use
Pediatrics
postoperative nausea and vomiting
Prospective Studies
Risk factors
Vomiting
Vomiting - chemically induced
Vomiting - epidemiology
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Summary:Introduction Despite preventive strategies, vomiting is an adverse event affecting patients with cancer. However, literature on the incidence and risk factors for vomiting in pediatric patients with cancer are scarce. Aim To assess the incidence and risk factors for vomiting within 24 h and goodness of fit for the Eberhart score in pediatric patients with hematologic cancers after receiving intrathecal chemotherapy under deep sedation. Methods This prospective cohort study included patients under 20 years of age with hematologic cancers who were scheduled to undergo intrathecal chemotherapy under anesthesia. The primary outcome was the occurrence of vomiting within 24 h after the end of anesthesia. Sociodemographic and procedure data and underlying diseases were collected. Patients were monitored during the procedure, in the postanesthesia care unit, and the day after (by phone call). Results A total of 139 patients were included, and the incidence of vomiting was 30.9% within 24 h after intrathecal chemotherapy under anesthesia, with 90.7% of vomiting prior to 6 h. Prophylactic ondansetron was administered prior to the procedure to 45.3% of patients. Risk factors for vomiting were female gender (hazard ratio: 2.47, 95% confidence interval: 1.35–4.53, p: .003), consolidation phase of treatment (hazard ratio: 2.16, 95% confidence interval: 1.10–4.24, p: .025), and history of kinetosis (hazard ratio: 2.49, 95% confidence interval: 1.31–4.70, p: .005). Incidence of vomit was higher than estimated by the Eberhart score distribution (observed incidence in patients with a score of zero: 33.3%; with a score of one: 28.8%; with a score of two: 60%). Conclusion A high incidence of vomiting was observed within 24 h after intrathecal chemotherapy under propofol deep sedation. Risk factors for this outcome were established (being female, consolidation phase of treatment, and previous kinetosis), and evidence suggested that the Eberhart score was not suitable for the studied population.
ISSN:1155-5645
1460-9592
DOI:10.1111/pan.14756