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Prevention of vomiting after general anesthesia for pediatric ophthalmic surgery

P V Smith1, D S Walton

  • 1Massachusetts Eye and Ear Infirmary, Boston, Mass., USA.

AANA Journal
|January 5, 2002
PubMed

Insights

A new anesthesia protocol significantly reduced postoperative vomiting in pediatric eye surgery patients. This approach, involving specific medications and gastric emptying, proved effective in minimizing nausea and vomiting after ophthalmic procedures.

Area of Science:

  • Anesthesiology
  • Pediatric Surgery
  • Ophthalmology

Background:

  • Postoperative vomiting (POV) is a common complication after pediatric surgery.
  • Pediatric ophthalmic surgery presents unique challenges for anesthesia management.
  • Minimizing POV is crucial for patient recovery and preventing complications like increased intraocular pressure.

Purpose of the Study:

  • To evaluate the effectiveness of a multifaceted general anesthesia protocol in reducing POV after pediatric eye surgery.
  • To assess the incidence of POV and associated complications in children undergoing ophthalmic procedures.

Main Methods:

  • A cohort of 150 children (2 weeks to 18 years) undergoing ophthalmic surgery received a standardized anesthesia protocol.
  • The protocol included mask or IV induction, maintenance with volatile agents, morphine for pain, gastric aspiration, and pre-emptive administration of metoclopramide and ondansetron.
  • Patients were monitored for POV for 24 hours postoperatively.

Main Results:

  • The incidence of POV was 7.3% (11 out of 150 patients).
  • Five of the 11 patients who vomited experienced acute elevation of intraocular pressure.
  • Vomiting was refractory to rescue ondansetron but responsive to intraocular pressure reduction.

Conclusions:

  • A comprehensive anesthesia protocol significantly decreases the incidence of POV in pediatric eye surgery.
  • Key elements include limited nitrous oxide, gastric emptying, and combined intravenous metoclopramide and ondansetron.
  • Effective management of POV is vital for preventing secondary complications such as elevated intraocular pressure.

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