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[The prevention of postoperative vomiting following strabismus surgery in children]
G B Kraus1, M Giebner, R Palackal
1Institut für Anaesthesiologie, Universität Erlangen-Nürnberg.
Insights
Preoperative droperidol effectively prevents nausea and vomiting in pediatric strabismus surgery patients. This antiemetic (anti-vomiting) drug, given before anesthesia, significantly reduced emesis compared to no treatment.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Pharmacology
Background:
- Pediatric patients undergoing strabismus surgery are at high risk for postoperative nausea and vomiting (PONV).
- PONV can lead to complications such as delayed discharge and patient distress.
- The optimal timing for administering antiemetic drugs like droperidol is unclear.
Purpose of the Study:
- To compare the efficacy of different administration timings of droperidol for preventing PONV in pediatric strabismus surgery.
- To evaluate the safety and side effects of droperidol in this patient population.
Main Methods:
- A randomized controlled trial involving 61 pediatric patients (ages 3-14) undergoing strabismus surgery.
- Three groups were studied: droperidol at anesthesia induction, droperidol during the final muscle suture, and a control group with no antiemetic.
- Standardized anesthesia protocols were used, including a gastric tube for stomach emptying.
Main Results:
- The incidence of nausea, retching, or vomiting was significantly lower in the preoperative droperidol group (10%) compared to the no-treatment group (45%).
- Droperidol administered during surgery showed a lower incidence (19%) than no treatment, but this was not statistically significant.
- No significant differences in operation time, extubation time, or extrapyramidal symptoms were observed between groups.
Conclusions:
- Preoperative administration of droperidol (75 mcg/kg IV) is recommended as the optimal prophylaxis for postoperative emesis in pediatric strabismus surgery.
- This regimen offers significant antiemetic benefits without severe side effects.
- Factors like gastric tube use, opioid avoidance, and surgeon experience may also contribute to reduced PONV.
Abstract:
Children recovering from anaesthesia for strabismus surgery are particularly prone to nausea and vomiting as a result of intraoperative vagus irritation. Besides being disturbing to the patient, vomiting can be dangerous during emergence from anesthesia and can result in delayed discharge. Droperidol is a powerful antiemetic drug that has been shown to reduce the incidence and severity of postoperative nausea and vomiting in pediatric strabismus patients, although the best timing for administration is not clear. MATERIAL AND METHODS. We compared three randomized groups totalling 61 patients. Droperidol 0.075 mg/kg i.v. was given either at induction of anesthesia after intubation (n = 20) or during the last muscle suture (n = 21). The third group received no antiemetic treatment. The patients' ages ranged from 3 to 14 years (mean 5.9 +/- 2.84 years). There was no difference in age or sex between the three groups. Anesthesia was standardized with rectal midazolam premedication, atropine, thiopental, succinylcholine, O2/N2O = 1:2, enflurane, intubation, and a gastric tube. RESULTS. Nausea, retching, or vomiting occurred in 2/20 children (10%) given droperidol preoperatively, 4/21 children (19%) with droperidol during the operation, and 9/20 children (45%) with no antiemetic treatment. The difference between groups I and III was significant (p less than 0.05). Comparison of groups II and III and groups I and II showed no statistical significance. Operation time was similar in each group and there was no delay in time of extubation. In each group 1 case of hypotension occurred. No child showed extrapyramidal symptoms. The lower incidence of vomiting in all study groups compared to the literature is thought to be due to three factors: (1) emptying the stomach at the end of the operation by a gastric tube, which is removed before extubation; (2) avoidance of opioids; (3) surgical procedure being done by a very experienced surgeon in 57/61 children (12 vomiting versus 45 not vomiting) in contrast to 3/4 children vomiting postoperatively after surgery by a less experienced surgeon. CONCLUSIONS. We recommend preoperative droperidol 75 micrograms/kg i.v. as the best prophylaxis of postoperative emesis without severe side effects in pediatric strabismus surgery.