Anti sickness when ordansetron doesn't work

[elliejjtiny]

Ds is 9. He had an operation in January and despite anti sickness meds he was violently sick multiple times for the rest of the day after he woke up. I asked the nurse for more anti sickness meds but she said he'd had the maximum dose. Today we saw the consultant and I asked what anti sickness he'd had, thinking he'd just had something like cyclizine and there were better drugs available but he'd had ordansetron (sorry I can't spell it) which is the strong stuff. So now I'm worried about his next operation and what he can have to help with the sickness. Apart from being miserable for him being sick so much his next operation is in his mouth so I'm worried about infection if he gets vomit near the wound. The surgeon said that we have to be really careful about infection or the operation will fail and have to be done again which obviously I'm keen to avoid. Is there anything better than ordansetron or could he have a combination of different meds?

My son had two ops when he was 3 and almost 5. The first one he was absolutely fine and released the next morning. Second one he was violently sick for nearly 48 hours. It was an identical operation just on his right instead of left. I said to the nurse I couldn't believe how different his reaction to the anaesthetic was and she said something like, "Different anaesthetist, lots of sickness this week."

So maybe your son won't be as sick next time, I hope so anyway.

I take ondansentron on a regular basis for migraine related sickness and sometimes it works sometimes it doesn't, sometimes it makes you feel worse to be quite honest, as so many of these things do.

I've also had a number of surgeries, some I've been sick as a dog afterwards (most of them) and some not at all and have felt surprisingly perky. I think quite often the combination of drugs used to initiate sedation/prevent sickness does differ (you can see what you were given and in what amount on the discharge sheet) depending on the need of the particular procedure. There are also always going to be other factors too - existing health, how well pre-surgical instructions were able to be adhered to and so on.

You're really best off speaking to the surgical team on admission day and at the pre-operative assessment to discuss options for post-operative meds. If it's imperative that infection doesn't set in post-operatively for this then I assume it will be quite likely he will be give a short course of antibiotics. The anaesthetist will usually see you before the surgery and that offers a chance to discuss any prior experiences with certain drugs and so on.

Whilst it is obviously unpleasant and not nice for a child in particular I do think sickness is regarded as a not unusual effect of anaesthesia, as is infection. They will know this and will plan accordingly if there is a particular risk of either.

Ondansetron is not better or stronger than cyclizine just a different drug. Both can be given Together (in adults anyway) was he given it IV? There is also prochloperazine which can be given

You’ll have to ask the anaesthesiologist as I don’t know what’s approved for children but IV cyclizine is great at nausea but makes you woozy, ondansetron is good but makes you constipated. Metaclopromide and Stematil are supposedly good but I’m allergic so sadly can’t have them. Promethazine is another but makes you very drowsy. Domperidone is ok but can interact with some meds.

There should be options and yes, welll for adults, it’s possible to take for example cyclizine and ondansetron together.

some hospitals such as Southampton (or so I’ve been told) have revoked the use of IV cyclizine as it can make you feel high. I ask for it to be diluted in a saline drip rather than straight in the cannula as it helps reduce this.

I only know so much as I take steroids so when I get puke I get sent to hospital. I’m also prone to infections…which cause vomiting….and thus I know my antiemetics well! Also had quite a few ops & get very pukey - however last op they anaesthetised me differently & it was plain sailing (I don’t think they changed me onto the gas & air….something like that I think). They have options. Just chat to them on the day of the op & they’ll work out a plan.

I'm always terribly, terribly sick after a GA. I have got more and more proactive about it though, and tell the anaesthetist that I am violently sick not just immediatly after coming round, but for a prolonged period - around 12 hours. Last time, I emphasised this and they gave me drugs during surgery and in a drip afterwards so it was a few hours and that worked really well

You need to talk to the anaesthetist (not the surgeon) beforehand.
There are lots of different antiemetics, though some (including some that have been mentioned here are unsuitable for children.) But yes, they can be used in combination and there are also potentially modifications that can be made to the anaesthetic technique that can reduce the risk of post op nausea and vomiting, though obviously that depends on both the patient abd the procedure. Unfortunately there are some people who will be sick post op come what may, but there's usually things we can do to help.
Make sure you follow the fasting instructions carefully. Obviously his stomach needs to be empty for safety reasons but really long periods nil by mouth actually make you more likely to feel or be sick, so don't fast him for longer than you are told to if you can help it. The other thing worth considering is accupressure wrist bands (one trade name is seabands but there are probably others). I don't know about children but there is some evidence of benefit in adults and I've used them with adults who have had intractable post op vomiting previously and they do seem to help some people. Apart from a few pounds you've nothing to lose by trying anyway - I think most chemists sell them and they need to go on pre op.
I hope it all goes smoothly.

Ondansetron isn't stronger, every anti-emetic works differently.

Mention it next time and the anaesthetist can change the mix of drugs.

I'm sick because of a reaction to anaesthetic.

I had iv anti sickness meds and specific anaesthetic that I was less likely to react to (it was bright yellow) and it didn't stop me being sick but I was definitely sick less and only for a few hours instead of 24.

Thank you. He will get oral antibiotics and a mouthwash as well to prevent infection. I think he got the ordansetron as a one off dose through his cannula last time while he was still asleep so I will ask about an iv next time.

in addition to all the things mentioned in @AgeingDoc 's post, it's worth knowing that some operations are more/less likely to cause nausea so having had it once doesn't necessarily mean it'll happen again.
Slightly random things that may help on top of the drugs are chewing gum and sniffing an alcohol swab (not a scooby what the mechanism for that is but i have a colleague who swears by it!).