Oculocardiac reflex and postoperative vomiting in paediatric strabismus surgery. A randomised controlled trial comparing four anaesthetic techniques

Acta Anaesthesiologica Scandinavica
M R TramèrK Rifat

Abstract

Oculocardiac reflex (OCR) and postoperative vomiting are major complications of paediatric strabismus surgery. 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. 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). Thiopental-isoflurane-air/O2-alfentanil resulted in a moderate risk of vomiting. Adding ondansetron signif...Continue Reading

References

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Citations

Nov 19, 2009·Journal of Anesthesia·So Ron ChoiChan Jong Chung
Apr 16, 2010·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Amy Rodgers, Robin G Cox
Feb 13, 2007·Paediatric Drugs·Anthony L Kovac
Apr 26, 2007·Clinical Medicine & Research·C K S OngR A Seymour
Apr 5, 2014·Journal of AAPOS : the Official Publication of the American Association for Pediatric Ophthalmology and Strabismus·Yu-Hung LaiKwou-Yeung Wu
Oct 24, 2003·International Anesthesiology Clinics·Olutoyin Olutoye, Mehernoor F Watcha
Nov 28, 2000·Equine Veterinary Journal·A K Parviainen, C M Trim
Jul 18, 2017·The Cochrane Database of Systematic Reviews·John Carlisle, Carl A Stevenson
Apr 21, 2018·BMC Ophthalmology·Suk-Gyu HaSeung-Hyun Kim
Jul 2, 2021·Clinical Ophthalmology·Robert W Arnold

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