Real-World Impact on Postoperative Vomiting by Changing Anesthesia Regimens in Children Undergoing Strabismus...

Area of Science:

• Anesthesiology
• Pediatric Surgery
• Pharmacology

Background:

• Postoperative vomiting (POV) is a concern in pediatric strabismus surgery.
• Propofol-based total intravenous anesthesia (TIVA), dexamethasone (DEX), and ondansetron (OND) have shown individual antiemetic effects.
• The combined effect of DEX and OND with propofol/opioid TIVA on POV in real-world settings is not well-documented.

Purpose of the Study:

• To assess the longitudinal incidence of POV in pediatric strabismus surgery.
• To compare POV rates across three distinct anesthesia regimens.
• To evaluate the impact of anesthetic modifications on POV prevention.

Main Methods:

• Retrospective observational study at a Japanese tertiary-care children's hospital.
• Included children under 18 undergoing strabismus surgery without major comorbidities.
• Analyzed POV or antiemetic use within 24 hours across three phases: sevoflurane/pentazocine, propofol/opioid TIVA with DEX, and propofol/opioid TIVA with DEX and OND.

Main Results:

• Overall POV incidence decreased significantly from 23.1% (Phase 1) to 6.9% (Phase 2) (p < 0.001).
• Further addition of OND in Phase 3 resulted in a POV incidence of 4.3%, with no significant change from Phase 2.
• Interrupted time series analysis showed a significant level change in POV from Phase 1 to 2, but not from Phase 2 to 3.

Conclusions:

• Switching to propofol/opioid TIVA with DEX effectively reduced POV in pediatric strabismus surgery.
• Adding OND to propofol/opioid TIVA with DEX did not provide additional significant reduction in POV.
• Further research is needed to optimize antiemetic strategies combining medications within TIVA for real-world application.