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Clinical Impact of Specific Extraocular Muscle Manipulation and the Oculocardiac Reflex on Postoperative Vomiting in

Taiki Kojima1,2, Yusuke Yamauchi1, Takashi Fujiwara3

  • 1Department of Anesthesiology, Aichi Children's Health and Medical Center, Obu, Japan.

Paediatric Anaesthesia
|November 30, 2024
PubMed

Insights

Inferior oblique muscle manipulation during pediatric strabismus surgery increases the risk of postoperative vomiting. The oculocardiac reflex was not found to be associated with this risk.

Area of Science:

  • Ophthalmology
  • Pediatric Anesthesia
  • Surgical Risk Assessment

Background:

  • Pediatric strabismus surgery carries a high risk of postoperative vomiting.
  • Current guidelines for preventing postoperative vomiting in children are based on heterogeneous surgical populations.
  • Specific risk factors for postoperative vomiting in pediatric strabismus surgery, including extraocular muscle manipulation and the oculocardiac reflex, are not well-defined.

Purpose of the Study:

  • To investigate the association between inferior oblique muscle manipulation and the oculocardiac reflex with postoperative vomiting in pediatric strabismus surgery patients.
  • To identify specific risk factors for postoperative vomiting in this population.

Main Methods:

  • A multicenter retrospective cross-sectional study was conducted.
  • Included were children under 18 years old undergoing strabismus surgery without major comorbidities.
  • The primary exposure assessed was inferior oblique muscle manipulation, with postoperative vomiting or antiemetic use as the main outcome.

Main Results:

  • Inferior oblique muscle manipulation was significantly associated with an increased risk of postoperative vomiting (adjusted odds ratio, 1.58; p = 0.005).
  • The oculocardiac reflex was not found to be associated with postoperative vomiting (adjusted odds ratio, 1.06; p = 0.73).
  • Postoperative vomiting occurred in 13.6% of children with inferior oblique muscle manipulation versus 9.6% without.

Conclusions:

  • Inferior oblique muscle manipulation is a significant risk factor for postoperative vomiting in pediatric strabismus surgery.
  • Enhanced preventive measures for postoperative vomiting are recommended for children undergoing procedures involving inferior oblique muscle manipulation.
  • The oculocardiac reflex is not associated with postoperative vomiting in this specific surgical context.
Abstract

Keywords:
childrengeneral anesthesiaoculomotor musclepostoperative nausea and vomitingstrabismus

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