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Myopexy (Faden) results in more postoperative vomiting after strabismus surgery in children
M Saiah1, A Borgeat, Y A Ruetsch
1Department of Anaesthesiology, Orthopaedic University Clinic of Zurich/Balgrist, Switzerland.
Insights
The Faden surgical method for strabismus correction in children significantly increases the risk of postoperative vomiting. This finding highlights the need for antiemetic prophylaxis in children undergoing this specific surgical technique.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Anesthesiology
Background:
- Strabismus correction surgery in children frequently leads to postoperative nausea and vomiting (PONV).
- Understanding the impact of surgical techniques on PONV is crucial for patient management.
Purpose of the Study:
- To investigate the influence of different surgical methods for strabismus correction on the incidence of postoperative vomiting in children.
Main Methods:
- A prospective, double-blind study involving 120 children (aged 2-12 years) undergoing strabismus surgery.
- Standardized total intravenous anesthesia was administered.
- Patients were divided into Faden (myopexy) and non-Faden groups, with vomiting episodes recorded over 48 hours postoperatively.
Main Results:
- The Faden group exhibited a significantly higher incidence of vomiting (53% vs. 12%, P<0.05).
- Operation time was longer in the Faden group.
- The Faden operation was identified as the sole independent risk factor for postoperative vomiting.
Conclusions:
- The surgical approach for pediatric strabismus correction substantially affects postoperative vomiting rates.
- The Faden operation is linked to a high incidence of postoperative vomiting, identifying these patients as high-risk.
- Consideration of antiemetic prophylaxis is recommended for children undergoing the Faden procedure.
Background:
Strabismus correction in children is associated with a high incidence of postoperative nausea and vomiting. The purpose of this prospective, double-blind study was to examine the influence of the surgical method for correction of squint on the incidence of postoperative vomiting.
Methods:
One hundred and twenty consecutive children aged 2-12 years, scheduled for elective strabismus surgery, were enrolled in this prospective, double-blind study. A standardised total intravenous anaesthesia was given to all children. The development of perioperative oculocardiac reflex was noted and the number of episodes of vomiting during the first 48 h postoperatively was recorded. At the completion of the study, the children who were operated with myopexy according to Faden, were allocated to a Faden group, those without a myopexy to the non-Faden group. All the patients included in this study were operated on by the same surgeon with standardised techniques.
Results:
The Faden group was younger, lighter and the operation time was longer (P<0.05). The incidence of vomiting was greater in the Faden group; 53% versus 12% (P<0.05). The incidence of oculocardiac reflex was similar in both groups; 40% in the Faden versus 28% in the non-Faden group, respectively. The total dose of propofol and alfentanil was similar between the groups. Requirement of analgesics for postoperative pain was similar in both groups. The only independent risk factor for postoperative vomiting was the Faden operation.
Conclusion:
The surgical method used for strabismus correction in children has a great influence on the incidence of postoperative vomiting. The Faden operation is associated with a very high incidence of postoperative vomiting; this particular group of patients has to be considered as a high risk group for postoperative vomiting and deserves an antiemetic prophylaxis.