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Oculocardiac reflex and postoperative vomiting in paediatric strabismus surgery. A randomised controlled trial
M R Tramèr1, A Sansonetti, T Fuchs-Buder
1Department of Anaesthesiology, Pharmacology and Surgical Intensive Care, Geneva University Hospital, Switzerland.
Insights
Ondansetron reduced vomiting after pediatric strabismus surgery, but propofol anesthesia increased the risk of oculocardiac reflex (OCR). Careful anesthetic selection is crucial for patient safety.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Ophthalmology
Background:
- Oculocardiac reflex (OCR) and postoperative vomiting are significant complications in pediatric strabismus surgery.
- Effective anesthetic strategies are needed to minimize these risks.
Purpose of the Study:
- To compare the incidence of OCR and postoperative vomiting among different anesthetic techniques for pediatric strabismus surgery.
- To evaluate the efficacy of ondansetron and lignocaine in reducing these complications.
Main Methods:
- 157 children (3-16 years) undergoing strabismus surgery were randomized into four groups.
- Groups received either thiopentone-isoflurane or propofol anesthesia, with or without ondansetron or lignocaine.
- All patients received prophylactic atropine and alfentanil; nitrous oxide was omitted.
Main Results:
- Thiopentone-isoflurane anesthesia was associated with a 26% vomiting incidence within 6 hours, reduced to 8% with ondansetron (NNT=5.5).
- Propofol anesthesia did not differ in vomiting rates but significantly increased OCR risk (40% vs. 14% with isoflurane, NNH=3.9).
- Lignocaine added to propofol offered no benefit for vomiting or OCR.
Conclusions:
- Thiopentone-isoflurane with alfentanil poses a moderate vomiting risk, significantly reduced by ondansetron in the early postoperative period.
- Propofol-based anesthesia, even with lignocaine and atropine, increases OCR risk without improving antiemetic outcomes.
- Anesthetic choice significantly impacts the risk of OCR and postoperative vomiting in pediatric strabismus surgery.
Background:
Oculocardiac reflex (OCR) and postoperative vomiting are major complications of paediatric strabismus surgery.
Methods:
Children (3-16 yr) undergoing elective strabismus surgery as inpatients were randomly allocated to four anaesthetic techniques: (A) thiopentone induction and isoflurane maintenance; (B) as (A) plus ondansetron 5 mg x m(-2) i.v.; (C) propofol induction and maintenance; (D) as (C) plus lignocaine 2 mg x kg(-1) i.v. All children received prophylactic atropine 0.02 mg x kg(-1) and alfentanil. Nitrous oxide was omitted.
Results:
Data on 157 children were analysed. The cumulative incidence of vomiting within 6 and 24 h after surgery with thiopentone-isoflurane was 26% and 46%, respectively. Adding ondansetron decreased the incidence to 8% and 33%, respectively. This improvement was significant within 6 h only; the number-needed-to-treat was 5.5 (95% CI 2.9-46). Propofol was not different from thiopentone-isoflurane. The addition of lignocaine to propofol was of no benefit. The risk of an OCR was significantly increased with propofol (incidence 40%) compared with isoflurane (14%); the number-needed-to-harm was 3.9 (95% CI 2.6-8).
Conclusions:
Thiopental-isoflurane-air/O2-alfentanil resulted in a moderate risk of vomiting. Adding ondansetron significantly decreased this risk, but 6 children have to be treated for one to benefit in the early postoperative period. Propofol and propofol-lignocaine showed no benefit on vomiting but significantly increased the risk of an OCR despite high-dose prophylactic atropine.