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Propofol anaesthesia and vomiting after myringoplasty in children
1Department of Anaesthesia, Princess Margaret Hospital for Children, Perth, WA, Australia.
Insights
Propofol anesthesia did not significantly reduce overall nausea and vomiting after ear surgery in children. However, it did lower vomiting incidence in the first two hours and reduced the need for rescue anti-emetics.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Pharmacology
Background:
- Postoperative nausea and vomiting (PONV) is a common complication in children following ear surgery.
- Various anesthetic agents are used, but their efficacy in preventing PONV in this specific population requires further investigation.
Purpose of the Study:
- To evaluate the effectiveness of propofol anesthesia in reducing the incidence of nausea and vomiting in children undergoing ear surgery compared to inhalational anesthesia.
Main Methods:
- A randomized controlled trial involving 40 children (aged 4-16 years) comparing propofol-based anesthesia with inhalational anesthesia (isoflurane-nitrous oxide).
- Nausea and vomiting were monitored for 24 hours post-surgery.
- Metoclopramide was administered as a rescue anti-emetic for excessive vomiting.
Main Results:
- No significant difference in the overall incidence of nausea and vomiting between the propofol (55%) and inhalational (70%) anesthesia groups.
- A significantly lower incidence of vomiting was observed in the propofol group within the first 2 hours post-surgery (0% vs. 25%, p < 0.05).
- Fewer children in the propofol group required rescue anti-emetics (10% vs. 40%, p < 0.05).
Conclusions:
- Propofol anesthesia alone is not sufficient to prevent vomiting after middle ear surgery in children.
- Propofol may offer a benefit in reducing early postoperative vomiting and the need for rescue anti-emetics.
Abstract:
To determine whether propofol anaesthesia reduces the incidence of nausea and vomiting after ear surgery, 40 children aged 4-16 years were randomly assigned to receive either propofol or inhalational anaesthesia. Children in the propofol group had anaesthesia induced with propofol and maintained with propofol-nitrous oxide and those in the inhalational group had anaesthesia induced with thiopentone and maintained with isoflurane-nitrous oxide. Nausea and vomiting were recorded for 24 h after surgery and metoclopramide was offered to children who vomited more than twice. We found that 11 children (55%) who had propofol and 14 children (70%) who had inhalational anaesthesia vomited one or more times after surgery (difference not significant). The incidence of vomiting was lower in the propofol group during the first 2 h after surgery (0% and 25% propofol and inhalational groups, respectively) (p < 0.05) but was similar at all other time intervals. Rescue anti-emetic was given to two (10%) and eight (40%) children in the propofol and inhalational groups, respectively (p < 0.05). We conclude that propofol anaesthesia alone is not an effective means of preventing vomiting after middle ear surgery in children.