ストラビズム手術を受けた子供の麻酔療法の変更による術後の嘔吐に対する現実世界の影響:中断されたタイムシリーズ分析
Taiki Kojima1,2, Yusuke Yamauchi3, Sayuri Yasuda4
1Department of Anesthesiology, Aichi Children's Health and Medical Center, Obu, Japan.
Paediatric anaesthesia
|August 22, 2025
まとめ
プロポフォール/ オピオイドによる静脈内全麻酔 (TIVA) とデキサメタゾン (DEX) への移行は,小児ストラビズム手術における手術後の嘔吐 (POV) を有意に減少させた. この治療法にオンダンセトロンを追加しても,POVの発生率はさらに低下しなかった.
科学分野:
- 麻酔科
- 小児外科
- 薬理学について
背景:
- 術後の嘔吐 (POV) は,小児ストラビズム手術における懸念事項である.
- プロポフールベースの静脈内全麻酔 (TIVA),デキサメトソン (DEX),オンドンセトロン (OND) は個別の反嘔吐効果を示した.
- プロポフォール/オピオイドTIVAとDEXとONDの組み合わせによるPOVの効果は,実用的な環境では十分に文書化されていない.
研究 の 目的:
- 小児ストラビズム手術における POV の縦断的発生率を評価する.
- 3つの異なる麻酔療法の POV 率を比較するために
- 麻酔薬の改変がPOV予防に与える影響を評価する.
主な方法:
- 日本の小児病院での遡及的観察研究
- 重大な併発性疾患のない 18 歳未満の子供を含む.
- セボフルーラン/ペンタゾシン,プロポフォール/オピオイドTIVAとDEX,プロポフォール/オピオイドTIVAとDEXとONDを組み合わせて24時間以内にPOVまたは反嘔剤の使用を分析した.
主要な成果:
- 全体的にPOVの発生率は23. 1% (第1期) から6. 9% (第2期) に大幅に減少した (p < 0. 001).
- ステージ3でのONDの追加により,POVの発生率は4. 3%となり,ステージ2から有意な変化はなかった.
- 断絶されたタイムシリーズの分析では,POVのレベルはフェーズ1からフェーズ2に変化したが,フェーズ2からフェーズ3には変化しなかった.
結論:
- プロポフォール/オピオイドのTIVAとDEXへの移行は,小児ストラビズム手術におけるPOVを効果的に低下させた.
- プロポフォール/オピオイドのTIVAにDEXを添加すると,POVがさらに有意に低下することはなかった.
- TIVA内の薬剤を組み合わせた抗嘔吐戦略を最適化するために,さらなる研究が必要である.
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