Postoperative nausea and vomiting after Faden operation

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.