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Oculocardiac reflex and postoperative vomiting in paediatric strabismus surgery. A randomised controlled trial comparing four anaesthetic techniques
Author(s) -
Tramer Dr.M. R.,
Sansonetti A.,
FuchsBuder T.,
Rifat K.
Publication year - 1998
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/j.1399-6576.1998.tb05091.x
Subject(s) - medicine , propofol , anesthesia , ondansetron , isoflurane , vomiting , strabismus surgery , postoperative nausea and vomiting , oculocardiac reflex , atropine , alfentanil , strabismus , surgery , reflex
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 · m ‐2 iv; (C) propofol induction and maintenance; (D) as (C) plus lignocaine 2 mg · kg ‐1 iv. All children received prophylactic atropine 0.02 mg · 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 thio‐pentone‐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/O 2 ‐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.