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Rescue Emetic Therapy for Children Having Elective Surgery (RETCHES)

The recruitment status of this study is unknown. The completion date has passed and the status has not been verified in more than two years.
Verified September 2009 by Children's Hospital of Pittsburgh.
Recruitment status was:  Recruiting
Information provided by:
Children's Hospital of Pittsburgh Identifier:
First received: February 10, 2010
Last updated: June 21, 2011
Last verified: September 2009

To compare ondansetron, metoclopramide, diphenhydramine, and placebo in order to determine which anti-emetic is most efficacious as a "rescue therapy" for pediatric patients ages 3-18 who have post-operative vomiting after a standardized prophylactic regimen of ondansetron and dexamethasone. We hypothesize that anti-emetics with a different mechanism of action than the prophylactic regimen will be the most effective "rescue therapy" in children having surgery in an ambulatory surgery center.

  1. Problem: Despite commonly-used anti-emetics for prophylaxis, some children still go on to develop post-operative vomiting (POV).

    Goal: To determine which anti-emetic--ondansetron, metoclopramide, diphenhydramine, or placebo--is most efficacious for pediatric patients in this situation.

  2. Hypothesis: Anti-emetic medications that have a different mechanism of action than the prophylactic regimen will be the most efficacious "rescue therapy."
  3. Hypothesis: Metoclopramide at the dose of 0.5 mg/kg (max dose 20 mg) will be more effective than ondansetron, diphenhydramine, or placebo as "rescue therapy."

Condition Intervention
Post Operative Nausea and Vomiting Rescue Emetic Therapy Drug: Metaclopramide Drug: Ondansetron Drug: diphenhydramine Drug: Saline

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Rescue Emetic Therapy for Children Having Elective Therapy

Resource links provided by NLM:

Further study details as provided by Children's Hospital of Pittsburgh:

Primary Outcome Measures:
  • Primary-Incidence of POV after rescue antiemetic in PACU, car ride home, day of surgery, and POD #1 and 2 [ Time Frame: 48 hrs ]

Secondary Outcome Measures:
  • Secondary - a. Discharge times [ Time Frame: 48 hrs ]
  • Adverse events (headaches, sedation, dystonic reaction, dry mouth) [ Time Frame: 48 hrs ]
  • POV risk factors. age, personal or family history of PONV, history of motion sickness, personal or family history of smoking [ Time Frame: 48 hrs ]

Estimated Enrollment: 1600
Study Start Date: February 2010
Estimated Study Completion Date: February 2014
Estimated Primary Completion Date: February 2012 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Metoclopramide
rescue emetic therapy
Drug: Metaclopramide
0.5 mg/kg for rescue after PONV
Experimental: Ondansetron
Rescue emetic therapy
Drug: Ondansetron
0.1 mg/kg (max 4 mg0
Experimental: Diphenhydramine
Rescue emetic therapy
Drug: diphenhydramine
0.25 mg/kg (max 25 mg)
Placebo Comparator: Saline
Drug: Saline
equal volume (5 ml)as experimental rescue medications


Ages Eligible for Study:   3 Years to 18 Years   (Child, Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes

Inclusion Criteria:

  1. Pediatric patients 3-17 years old
  2. Patients scheduled for tonsillectomy and/or adenoidectomy (with and without myringotomy) , or dental restoration,
  3. Patients receiving a general anesthetic (inhaled agent without nitrous oxide) with POV prophylaxis with two agents (ondansetron and dexamethasone)
  4. Post operative vomiting in PACU or second stage recovery requiring antiemetic rescue.

Exclusion Criteria:

  1. Vomiting in the past 24 hours or antiemetics in previous 24 hours
  2. Allergy or sensitivity to ondansetron, dexamethasone, metoclopramide, or diphenhydramine
  3. Patients with diabetes
  4. Patients with seizures
  5. Patients receiving a benzodiazepine premedication
  Contacts and Locations
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Please refer to this study by its identifier: NCT01067677

Contact: Franklyn P Cladis, MD 412-692-5260

United States, Pennsylvania
The Children's Hospital of Pittsburgh Recruiting
Pittsburgh, Pennsylvania, United States, 15210
Contact: Franklyn P Cladis, MD    412-692-5260   
Principal Investigator: Franklyn P Cladis, MD         
Sub-Investigator: Kathy Fertal, RN         
Sub-Investigator: Slava Martyn         
Sub-Investigator: Susan Woelfel, MD         
Sub-Investigator: Neal Campbell, MD         
Sponsors and Collaborators
Children's Hospital of Pittsburgh
Principal Investigator: Franklyn P Cladis, MD University of Pittsburgh
  More Information

Responsible Party: Franklyn Cladis MD, University of Pittsburgh, Department of Anesthesiology Identifier: NCT01067677     History of Changes
Other Study ID Numbers: 1-Cladis
Study First Received: February 10, 2010
Last Updated: June 21, 2011

Keywords provided by Children's Hospital of Pittsburgh:
Post operative nausea and vomiting
rescue emetic therapy

Additional relevant MeSH terms:
Postoperative Nausea and Vomiting
Signs and Symptoms, Digestive
Signs and Symptoms
Postoperative Complications
Pathologic Processes
Autonomic Agents
Peripheral Nervous System Agents
Physiological Effects of Drugs
Gastrointestinal Agents
Dermatologic Agents
Serotonin Antagonists
Serotonin Agents
Neurotransmitter Agents
Molecular Mechanisms of Pharmacological Action
Antipsychotic Agents
Tranquilizing Agents
Central Nervous System Depressants
Psychotropic Drugs
Anti-Anxiety Agents
Dopamine D2 Receptor Antagonists
Dopamine Antagonists processed this record on September 18, 2017