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Postoperative nausea and vomiting after Faden operation
I D Welters1, M Graef, T Menges
1Department of Anaesthesiology and Operative Intensive Care, Rudolf-Buchheim-Strasse 7, D-35385 Giessen, Germany. Ingeborg.D.Welters@chiru.med.uni-giessen.de
Insights
Prophylactic dimenhydrinate reduced the severity of postoperative nausea and vomiting (PONV) after bimedial Faden (BMF) surgery in children. While not reducing overall incidence, it decreased the need for rescue antiemetics for PONV.
Area of Science:
- Ophthalmology
- Anesthesiology
- Pediatric Surgery
Background:
- Postoperative nausea and vomiting (PONV) is a common complication following pediatric strabismus surgery.
- The bimedial Faden (BMF) operation is associated with a higher incidence of PONV compared to the horizontal recess-resect (R&R) procedure.
- Evaluating prophylactic antiemetic strategies is crucial for improving patient outcomes.
Purpose of the Study:
- To assess the antiemetic efficacy of dimenhydrinate administered before BMF surgery.
- To compare PONV rates between BMF and R&R procedures.
- To determine if dimenhydrinate reduces the need for rescue antiemetic medication.
Main Methods:
- A prospective, double-blind, placebo-controlled study involving 99 children (4-10 years) undergoing BMF surgery.
- Participants received either dimenhydrinate suppositories or placebo 30 minutes before anesthesia induction.
- PONV incidence and severity were compared between the dimenhydrinate group, placebo group, and a historical R&R surgery cohort.
Main Results:
- PONV requiring rescue medication was significantly more frequent after BMF (45%) compared to R&R surgery (23%).
- Dimenhydrinate administration significantly reduced the severity of PONV in the BMF group compared to placebo.
- The overall incidence of PONV after BMF was not significantly reduced by prophylactic dimenhydrinate.
Conclusions:
- BMF surgery is associated with a higher incidence of PONV than R&R surgery, likely due to its greater invasiveness.
- Preoperative dimenhydrinate effectively reduces the need for rescue antiemetic medication for PONV after BMF.
- Prophylactic dimenhydrinate is a valuable strategy for managing PONV severity in pediatric patients undergoing BMF surgery.
Objective:
The purpose of this study was to evaluate the antiemetic effect of prophylactic dimenhydrinate application prior to Faden operation and to compare the incidence of PONV between bimedial Faden operation (BMF) and horizontal recess-resect procedure (R&R).
Methods:
Ninety-nine children (4-10 years) scheduled for BMF were included in this prospective double-blind study. Midazolam (0.5 mg/kg body weight, BW) was administered orally for premedication 30 min before induction of anesthesia. Additionally, children weighing >/=23 kg received either dimenhydrinate suppositories or placebo. The placebo group was compared with 148 children who underwent R&R surgery without antiemetic prophylaxis during the same period. Anesthesia was induced with thiopentone (5-10 mg/kg BW) and vecuronium (0.1 mg/kg BW) bromide and maintained with halothane (1-2 vol%) in N(2)O/O(2) (65/35 vol%). Age, height, weight, and incidence of oculocardiac reflex were documented. PONV was classified into "no vomiting", "vomiting without therapy", and "vomiting requiring rescue medication". In the latter case dimenhydrinate was given again. The chi-square test was used for statistical analysis.
Results:
Forty-eight patients received placebo, while 51 received dimenhydrinate. No differences between any groups were observed concerning age, height, weight, and incidence of oculocardiac reflex. Compared to R&R surgery, PONV requiring rescue medication occurred significantly more frequently after BMF (45% vs 23% after R&R). PONV after BMF was significantly less severe in the dimenhydrinate group than in the placebo group. The total incidence of PONV after BMF, however, was not significantly reduced.
Conclusion:
The high incidence of PONV after BMF can be explained by the greater invasiveness of BMF than R&R surgery. PONV requiring antiemetic rescue medication can be reduced by preoperative administration of dimenhydrinate suppositories.