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Reduction of postoperative nausea and vomiting by dimenhydrinate suppositories after strabismus surgery in children
I D Welters1, T Menges, M Gräf
1Department of Anesthesiology and Strabismology and Neuroophthalmology, University of Giessen, Germany.
Insights
Rectal dimenhydrinate effectively prevents postoperative nausea and vomiting (PONV) in children undergoing strabismus surgery. While reducing PONV incidence, it may increase recovery time due to sedative effects.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Pharmacology
Background:
- Postoperative nausea and vomiting (PONV) is a common complication in pediatric surgery.
- Dimenhydrinate has a long history of use, but controlled efficacy studies for PONV prevention are limited.
Purpose of the Study:
- To evaluate the efficacy of prophylactic rectal dimenhydrinate in preventing PONV in children undergoing strabismus surgery.
- To assess the impact of dimenhydrinate on recovery time and arousal post-anesthesia.
Main Methods:
- A double-blinded, randomized study involving 301 children (4-10 years) undergoing strabismus surgery.
- Participants received midazolam pre-anesthesia, followed by either dimenhydrinate suppositories or placebo 30 minutes before anesthesia induction.
- Anesthesia maintained with halothane; PONV incidence, rescue medication needs, and recovery parameters were recorded.
Main Results:
- The incidence of PONV was significantly lower in the dimenhydrinate group (30.7%) compared to the placebo group (60.1%).
- Children receiving dimenhydrinate required longer observation in the recovery room and exhibited lower arousal scores upon discharge.
- No data on rescue dimenhydrinate requirements or specific PONV types were detailed.
Conclusions:
- Rectal dimenhydrinate is effective in preventing PONV in pediatric patients undergoing strabismus surgery.
- The prophylactic use of dimenhydrinate may lead to increased sedation, necessitating extended postoperative monitoring.
Unlabelled:
Although dimenhydrinate has been used for treatment and prevention of postoperative nausea and vomiting (PONV) since the fifties, there have been few controlled studies about its efficacy. We performed a double-blinded study of 301 children aged 4 to 10 yr who underwent strabismus surgery. Preanesthetic medication with midazolam (0.5 mg/kg) as well as application of either dimenhydrinate suppositories or a placebo preparation was performed 30 min before the induction of anesthesia. Anesthesia was induced with thiopentone (5-10 mg/kg) and vecuronium (0.1 mg/kg) and maintained with halothane (1%-2%) in N(2)O/O(2) (65%/35%). The incidence of PONV, requirements for rescue dimenhydrinate, and time to recovery were recorded. The overall incidence of PONV was 60.1% in the placebo group and 30.7% in the dimenhydrinate group. In the dimenhydrinate group, children had to be observed in the recovery room significantly longer than those in the placebo group. Children having received dimenhydrinate were discharged from the recovery room with lower arousal scores. We conclude that the rectal administration of dimenhydrinate is effective for the prevention of PONV, although the sedative effect may require longer postoperative monitoring.
Implications:
We performed a double-blinded, randomized study to investigate the effects of prophylactic rectal dimenhydrinate application on postoperative nausea and vomiting in children undergoing strabismus surgery. In comparison with placebo, dimenhydrinate reduced the incidence of postoperative vomiting from 60.1% to 30.7%.