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Propofol reduces emesis after sufentanil supplemented anaesthesia in paediatric squint surgery
T Standl1, S Wilhelm, G von Knobelsdorff
1Department of Anaesthesiology, University Hospital Eppenforf, Hamburg, Germany.
Insights
Propofol-sufentanil anesthesia significantly reduces postoperative nausea and vomiting in children undergoing squint surgery compared to isoflurane. This anesthesia approach offers a safer, more comfortable recovery with fewer antiemetic needs.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Pharmacology
Background:
- Squint surgery frequently leads to postoperative nausea and vomiting (PONV) in children.
- Understanding anesthetic influences on PONV is crucial for pediatric surgical care.
Purpose of the Study:
- To compare the incidence of PONV in children undergoing squint surgery.
- To evaluate the impact of propofol versus isoflurane anesthesia on PONV.
Main Methods:
- A prospective study involving 90 children (3-10 years) randomly assigned to three anesthesia groups.
- Anesthesia maintenance involved propofol (Groups 1 & 2) or isoflurane (Group 3), with varying oxygen and nitrous oxide concentrations.
- Incidence, frequency of nausea/vomiting, and antiemetic requirements were recorded.
Main Results:
- Group 3 (isoflurane) showed significantly higher overall incidence (70%) and frequency (74%) of nausea and vomiting compared to Group 1 (13%) and Group 2 (20%).
- Antiemetic requirements and postoperative recovery/surveillance time were longer in the isoflurane group.
- Propofol-based anesthesia, with or without nitrous oxide, demonstrated lower PONV rates.
Conclusions:
- Propofol-sufentanil anesthesia is associated with significantly less postoperative emesis and treatment needs in children undergoing squint surgery.
- This anesthesia technique is recommended for pediatric squint surgery due to its favorable impact on early postoperative recovery.
Background:
Squint surgery is associated with a high incidence of postoperative emesis. The purpose of this prospective study was to examine the influence of propofol and isoflurane anaesthesia on the incidence of postoperative nausea and vomiting in children.
Methods:
Ninety children aged 3-10 years were randomly allocated to one of 3 groups. In all groups, children received 2 mg/kg propofol, 0.5 microgram/kg sufentanil and 0.5 mg/kg atracurium for induction of anaesthesia. In group 1, anaesthesia was maintained with 15-20 mg/kg.h propofol and children were ventilated with 30% O2 in air. In group 2, anaesthesia was maintained with 10-15 mg/kg.h propofol and 30% O2 in N2O. In group 3, anaesthesia was maintained with 1.0-1.5 Vol% isoflurane and 30% O2 in N2O. The time of extubation, awakening and postoperative surveillance, the incidence and numbers of episodes of postoperative nausea and vomiting were registered as well as requirements of antiemetics. Statistics were made using ANOVA and Chi-square test or Kruskal-Wallis test with P < 0.05 considered as significant.
Results:
The overall incidence of nausea (P = 0.0001) and vomiting (P = 0.002) was higher in group 3 (70%;73%) than in group 1 (13%;23%) and 2 (20%;28%). Episodes of nausea (P = 0.0001) and vomiting (P = 0.0013) were more frequent in group 3 (74%;69%) than in group 1 (13%;15%) and 2 (13%;16%). Antiemetic requirements were higher and the time of postoperative sleep and surveillance was longer in group 3 than in group 1 and 2 (P = 0.04).
Conclusion:
Propofol-sufentanil anaesthesia results in less emesis and treatment during the early postoperative phase irrespective of N2O administration compared with propofol-induced isoflurane anaesthesia and may be recommended in children undergoing squint surgery.