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Nitrous oxide does not increase vomiting in children after myringotomy
W M Splinter1, D J Roberts, E J Rhine
1Department of Anaesthesia, Children's Hospital of Eastern Ontario, Ottawa, Canada.
Insights
Nitrous oxide (N2O) did not significantly increase postoperative vomiting in children undergoing myringotomy. Age was a key factor, with older children experiencing more vomiting, regardless of N2O use.
Area of Science:
- Anesthesiology
- Pediatric Surgery
Background:
- Postoperative vomiting is a common concern in pediatric surgical patients.
- Nitrous oxide (N2O) is frequently used in general anesthesia and its emetogenic potential in children is debated.
Purpose of the Study:
- To determine if nitrous oxide (N2O) administration during general anesthesia impacts the incidence of postoperative vomiting in children undergoing myringotomy.
Main Methods:
- A randomized controlled trial involving 320 healthy children (0.5-13 years) undergoing myringotomy.
- Anesthesia was induced and maintained with either 70% N2O/30% O2/halothane or 100% O2/halothane.
- Vomiting incidence was recorded in the recovery room, day care unit, and via parental follow-up 24-48 hours post-discharge.
Main Results:
- The overall incidence of postoperative vomiting was 13% in both the N2O and control groups.
- Vomiting incidence increased significantly with age, ranging from 4% in children under 3 to 31% in those aged 9-13.
- N2O administration did not alter the incidence of vomiting, nor was it influenced by sex or anesthesia duration.
Conclusions:
- Nitrous oxide does not appear to induce clinically significant postoperative vomiting in children after myringotomy.
- Age is a significant predictor of postoperative vomiting in this pediatric surgical population.
- Further research may explore other factors influencing postoperative nausea and vomiting in children.
Abstract:
The aim of this study was to establish whether nitrous oxide has a clinically important effect on postoperative vomiting in children after myringotomy. We studied 320 healthy children of ages 0.5-13 yr undergoing elective myringotomy and tube insertion. Induction and maintenance of anaesthesia were randomized to inhalation with either 70% N2O/30% O2/halothane or 100%O2/halothane. Surgical technique and postoperative management were not influenced by this study. Vomiting in the recovery room (PAR) and Day Care Surgical Unit (DCSU) was recorded by nurses unaware of the anaesthetic technique. Parents were contacted 24-48 hr after surgery to ascertain the incidence of vomiting after discharge. The groups were similar with respect to demographic data, except that the anaesthesia time was greater among the 158 patients in the N2O-treated group (11 +/- 4 vs 12 +/- 4 min, mean +/- SD). The incidence of vomiting was 13% in both groups. Most of the 42 patients that had emesis only vomited once or twice. The incidence of vomiting was not altered by sex (13% vs 13%) or duration of anaesthesia. The incidence of vomiting increased with increasing age. The children aged less than 3 yr vomited 4% of the time, those aged 3-5 vomited 11% of the time, those aged 6-8 yr vomited 17% of the time, while the incidence of vomiting among those aged 9-13 yr was 31%. Vomiting prolonged the postoperative hospital stay from 75 to 92 min, P < 0.001, ANOVA. In summary, we have been unable to demonstrate that N2O induces vomiting by children after a brief general anaesthetic for myringotomy.