Related Experiment Videos
Postoperative vomiting following strabismus surgery in paediatric outpatients: spontaneous versus controlled
Insights
Controlled ventilation did not significantly reduce postoperative vomiting in children undergoing strabismus repair. Both spontaneous breathing and IPPV showed similar vomiting rates, with longer surgeries linked to emesis in the spontaneous breathing group.
Area of Science:
- Pediatric Anesthesiology
- Surgical Outcomes Research
Background:
- Postoperative vomiting (POV) is a common complication in pediatric outpatients.
- Optimizing anesthetic techniques to minimize POV is crucial for patient recovery and satisfaction.
Purpose of the Study:
- To compare the incidence and severity of postoperative vomiting in pediatric patients undergoing strabismus repair.
- To evaluate the impact of controlled ventilation (IPPV) versus spontaneous breathing (SV) on POV.
Main Methods:
- A randomized study of 120 unpremedicated children (2-12 years) undergoing strabismus repair.
- Patients received either spontaneous breathing (n=60) or IPPV (n=60) with halothane/N2O anesthesia.
- Neuromuscular blockade reversal was administered for the IPPV group.
Main Results:
- Vomiting incidence was 50% with SV and 40% with IPPV (p > 0.25).
- Longer operative times correlated with vomiting in the SV group, but not in the IPPV group.
- No significant correlation found between age, sex, surgery duration, or muscles repaired and vomiting or discharge time.
Conclusions:
- Intraoperative positive pressure ventilation (IPPV) did not offer a significant advantage over spontaneous breathing (SV) in reducing postoperative vomiting.
- Anesthetic management strategies should consider operative duration, particularly in spontaneously breathing pediatric patients.
Abstract:
The study was designed to compare the frequency and severity of postoperative vomiting in paediatric out-patients receiving controlled ventilation (IPPV) or breathing spontaneously (SV) during anaesthesia for strabismus repair. One hundred and twenty unpremedicated children (ages 2-12 years) were studied in a randomized fashion. After intravenous induction of anaesthesia and tracheal intubation, patients breathed halothane 1-1.5 per cent inspired and N2O 66 per cent in O2 spontaneously (n = 60), or received IPPV, halothane 0.5-1 per cent, N2O 66 per cent, and pancuronium 0.05 mg.kg-1, which was reversed with neostigmine and atropine (n = 60). The incidence of vomiting with SV was 50 per cent (95 per cent confidence limits: 34.5-65.5 per cent) compared with 40 per cent (24.5-55.5 per cent) with IPPV (p greater than 0.25). Patients in the SV group experiencing emesis had longer operations than those not vomiting (mean +/- SEM = 1.5 +/- 0.1 vs 1.2 +/- 0.1 hours, p less than 0.005). This was not the case with IPPV. There was no correlation between age, sex, duration of surgery, or number of extraocular muscles repaired, and frequency or severity of vomiting or time to discharge. No significant advantage was afforded by IPPV over SV in the present study.