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[PONV after strabismus surgery : Risk adapted prophylaxis?].

R Wolf1, E Morinello2, G Kestler1

  • 1Klinik für Anästhesiologie, Intensivtherapie & Schmerztherapie, Universitätsklinikum des Saarlandes (UKS), Gebäude 57, Kirrberger Straße, 66421, Homburg/Saar, Deutschland.

Der Anaesthesist
|June 14, 2016
PubMed
Summary

Postoperative nausea and vomiting (PONV) after strabismus surgery can be reduced by tailoring anesthetic techniques to individual patient risk. A risk-adapted approach using total IV anesthesia (TIVA) with antiemetics significantly lowered PONV incidence in high-risk children.

Keywords:
Apfel-ScorePostoperative nausea and vomiting (PONV)Postoperative vomiting in children (POVOC)Strabismus surgeryWengritzky-Score

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Area of Science:

  • Anesthesiology
  • Pediatric Surgery
  • Pharmacology

Background:

  • Postoperative nausea and vomiting (PONV) is a common complication following strabismus surgery, leading to discomfort and potential complications.
  • Existing debates surround the necessity and methodology of PONV prophylaxis, with differing views on liberal versus risk-adapted approaches.
  • Previous studies on score-based antiemetic prophylaxis have focused solely on adult patients.

Purpose of the Study:

  • To evaluate a risk-adapted anesthetic technique for reducing PONV in pediatric patients undergoing strabismus surgery.
  • To assess the efficacy of individualized PONV prophylaxis in children for the first time.

Main Methods:

  • 92 patients undergoing strabismus surgery were assessed for PONV risk using POVOC (children) and Apfel's (adults) scores.
  • Low-risk patients (0-2 factors) received balanced anesthesia; high-risk patients (3-4 factors) received total IV anesthesia (TIVA) with propofol.
  • High-risk patients also received dexamethasone and ondansetron as antiemetic prophylaxis; PONV was documented using the Wengritzky-Score.

Main Results:

  • The overall incidence of PONV was 17%.
  • High-risk patients receiving TIVA and multimodal antiemetics experienced significantly lower PONV rates (8-9%) compared to predicted values (OR = 0.26).
  • Low-risk patients receiving balanced anesthesia without prophylaxis had higher PONV rates (21% adults, 38% children).

Conclusions:

  • A risk-adapted approach, particularly TIVA with antiemetics, effectively reduces PONV in high-risk pediatric patients.
  • The overall PONV incidence was successfully reduced below 20%.
  • A more liberal approach to PONV prophylaxis is advocated due to the high incidence in patients with 2 risk factors and the effort of risk stratification.