Prophylactic Ondansetron in Prevention of Postoperative Nausea and Vomiting following Pediatric Strabismus Surgery

2000 ◽  
Vol 92 (4) ◽  
pp. 1035-1042 ◽  
Author(s):  
Senthilkumar Sadhasivam ◽  
Dilip Shende ◽  
Rashmi Madan
Keyword(s):  
Placebo Group ◽  
Outcome Measures ◽  
Postoperative Nausea ◽  
Postoperative Nausea And Vomiting ◽  
Strabismus Surgery ◽  
Nausea And Vomiting ◽  
Postanesthesia Care Unit ◽  
Assessment Scores ◽  
Parental Assessment ◽  
Prophylactic Use

Background This study evaluated the antiemetic effectiveness, dose-response, and clinical usefulness of prophylactic ondansetron in the prevention of postoperative nausea and vomiting (PONV) in children undergoing strabismus repair. Method The authors observed 180 children, American Society of Anesthesiologists physical status I or II, 2-12 yr of age, who were undergoing strabismus repair. After induction of anesthesia with halothane and nitrous oxide in oxygen or intravenous thiopental, children received either placebo (saline) or intravenous ondansetron in doses of 25, 50, 75, 100, and 150 /microg/kg (n = 30). The trachea was intubated and ventilation was controlled. Perioperative analgesic and fluid requirements were standardized. Episodes of nausea and vomiting were recorded for the first 24 h postoperatively. Data such as nonsurrogate (parental satisfaction scores and duration of postanesthesia care unit stay) and therapeutic (numbers needed to prevent and harm) outcome measures were collected. Results The incidences of PONV in the placebo and 25-, 50-, 75-, 100-, and 150-,microg/kg ondansetron groups were 83, 77, 47, 30, 30, and 27%, respectively. The incidence was less in the 75(P = 0.002), 100- (P = 0.002), and 150-microg/kg (P < 0.001) ondansetron groups compared with placebo. Duration of stay in the postanesthesia care unit was shorter in the 75-, 100-, and 150-microg/kg ondansetron groups (P < 0.002) compared with the placebo group. Parental assessment scores for the child's perioperative experience and the positive number needed to prevent PONV were also better and favorable in the 75-, 100-, and 150-microg/kg ondansetron groups compared with the placebo group. The incidence (P > 0.99) and severity (P = 0.63) of PONV were similar in the 75- and 150-microg/kg ondansetron groups. Surrogate, nonsurrogate, and therapeutic outcome measures revealed that 75 microg/kg ondansetron provided the same benefits as did 100 and 150 microg/kg. Conclusion The routine prophylactic use of ondansetron at a dose of 75 microg/kg is as effective as 150 microg/kg in preventing PONV and improving the "true" outcome measures after strabismus repair in children.

scholarly journals Effect of dexmedetomidine on prevention of postoperative nausea and vomiting in pediatric strabismus surgery: A randomized controlled study

2020 ◽  
Author(s):  
shuangshuang li ◽  
Tingjie Liu ◽  
Junming Xia ◽  
Jie Jia ◽  
Wenxian Li
Keyword(s):  
Clinical Trial ◽  
Placebo Group ◽  
Postoperative Nausea ◽  
Recovery Time ◽  
Pediatric Patients ◽  
Postoperative Nausea And Vomiting ◽  
Strabismus Surgery ◽  
Nausea And Vomiting ◽  
Emergence Agitation ◽  
Oculocardiac Reflex

Abstract Background: Postoperative nausea and vomiting (PONV) are common side-effects following strabismus surgery. The present study aimed to compare the effects of different doses of dexmedetomidine (DEX) on PONV incidence in pediatric patients undergoing strabismus surgery. Methods: In this prospective randomized double-blinded study, 126 pediatric patients undergoing strabismus surgery were randomized into one of three groups: Placebo group, normal saline; DEX1 group, 0.3 ug/kg dexmedetomidine, and DEX2 group, 0.5 ug/kg dexmedetomidine. Oculocardiac reflex (OCR) events were recorded during surgery. PONV or postoperative vomiting (POV) was recorded for 24 hours in the ward. Pediatric anesthesia emergence delirium (PAED) scale and emergence agitation (EA) scale were recorded in the recovery room. Results: Intraoperative OCR was significantly reduced in DEX2 group (42%) as compared to that of Placebo group (68%) (p=0.0146). During the first 24 hours post-op, the overall incidence of PONV was significantly lower in DEX2 group (10%) than that of Placebo group (32%) (p=0.0142). There was no significant difference in POV among the three groups. PAED or EA scores among the three groups were similar during recovery time. Conclusion: Dexmedetomidine (0.5 ug/kg) reduced OCR and PONV without lengthening extubation time or recovery time in pediatric patients undergoing strabismus surgery. Trial registration：The trial was prospectively registered before patient enrollment at Chinese Clinical Trial Registry (Clinical Trial Number: ChiCTR1800020176, Date: 12/19/2018). Keywords: Dexmedetomidine, Postoperative nausea and vomiting, Strabismus surgery, Oculocardiac reflex, Emergence agitation

scholarly journals Effect of dexmedetomidine on prevention of postoperative nausea and vomiting in pediatric strabismus surgery: A randomized controlled study

2020 ◽  
Author(s):  
shuangshuang li ◽  
Tingjie Liu ◽  
Junming Xia ◽  
Jie Jia ◽  
Wenxian Li
Keyword(s):  
Placebo Group ◽  
Postoperative Nausea ◽  
Recovery Time ◽  
Pediatric Patients ◽  
Postoperative Nausea And Vomiting ◽  
Strabismus Surgery ◽  
Nausea And Vomiting ◽  
Controlled Study ◽  
Extubation Time ◽  
Significant Difference

Abstract Background : Postoperative nausea and vomiting (PONV) are common side-effects following strabismus surgery. The present study aimed to compare the effects of different doses of dexmedetomidine (DEX) on PONV incidence in pediatric patients undergoing strabismus surgery. Methods : In this prospective randomized double-blinded study, 126 pediatric patients undergoing strabismus surgery were randomized into one of three groups: Placebo group, normal saline; DEX1 group, 0.3 ug/kg dexmedetomidine, and DEX2 group, 0.5 ug/kg dexmedetomidine. Oculocardiac reflex (OCR) events were recorded during surgery. PONV or postoperative vomiting (POV) was recorded for 24 hours in the ward. Pediatric anesthesia emergence delirium (PAED) scale and emergence agitation (EA) scale were recorded in the recovery room. Results : Intraoperative OCR was significantly reduced in DEX2 group (42%) as compared to that of Placebo group (68%) (p=0.0146). During the first 24 hours post-op, the overall incidence of PONV was significantly lower in DEX2 group (10%) than that of Placebo group (32%) (p=0.0142). There was no significant difference in POV among the three groups. PAED or EA scores among the three groups were similar during recovery time. Conclusion : Dexmedetomidine (0.5 ug/kg) reduced OCR and PONV without lengthening extubation time or recovery time in pediatric patients undergoing strabismus surgery.

scholarly journals Effect of dexmedetomidine on prevention of postoperative nausea and vomiting in pediatric strabismus surgery: A randomized controlled study

2019 ◽  
Author(s):  
shuangshuang li ◽  
Tingjie Liu ◽  
Junming Xia ◽  
Jie Jia ◽  
Wenxian Li
Keyword(s):  
Placebo Group ◽  
Postoperative Nausea ◽  
Recovery Time ◽  
Pediatric Patients ◽  
Postoperative Nausea And Vomiting ◽  
Strabismus Surgery ◽  
Nausea And Vomiting ◽  
Controlled Study ◽  
Extubation Time ◽  
Significant Difference

Abstract Background Postoperative nausea and vomiting (PONV) are common side-effects following strabismus surgery. The present study aimed to compare the effects of different doses of dexmedetomidine (DEX) on PONV incidence in pediatric patients undergoing strabismus surgery. Methods In this prospective randomized double-blinded study, 126 pediatric patients undergoing strabismus surgery were randomized into one of three groups: Placebo group, normal saline; DEX1 group, 0.3 ug/kg dexmedetomidine, and DEX2 group, 0.5 ug/kg dexmedetomidine. Oculocardiac reflex (OCR) events were recorded during surgery. PONV or postoperative vomiting (POV) was recorded for 24 hours in the ward. Pediatric anesthesia emergence delirium (PAED) scale and emergence agitation (EA) scale were recorded in the recovery room. Results Intraoperative OCR was significantly reduced in DEX2 group (41.5%) as compared to that of Placebo group (68.3%) (p=0.026). During the first 24 hours post-op, the overall incidence of PONV was significantly lower in DEX2 group (9.8%) than that of Placebo group (31.7%) (p=0.029). There was no significant difference in POV among the three groups. PAED or EA scores among the three groups were similar during recovery time. Conclusion Dexmedetomidine (0.5 ug/kg) reduced OCX and PONV without lengthening extubation time or recovery time in pediatric patients undergoing strabismus surgery.

scholarly journals Effect of dexmedetomidine on prevention of postoperative nausea and vomiting in pediatric strabismus surgery: A randomized controlled study

2020 ◽  
Author(s):  
shuangshuang li ◽  
Tingjie Liu ◽  
Junming Xia ◽  
Jie Jia ◽  
Wenxian Li
Keyword(s):  
Placebo Group ◽  
Postoperative Nausea ◽  
Recovery Time ◽  
Pediatric Patients ◽  
Postoperative Nausea And Vomiting ◽  
Strabismus Surgery ◽  
Nausea And Vomiting ◽  
Controlled Study ◽  
Extubation Time ◽  
Significant Difference

Abstract Background : Postoperative nausea and vomiting (PONV) are common side-effects following strabismus surgery. The present study aimed to compare the effects of different doses of dexmedetomidine (DEX) on PONV incidence in pediatric patients undergoing strabismus surgery. Methods : In this prospective randomized double-blinded study, 126 pediatric patients undergoing strabismus surgery were randomized into one of three groups: Placebo group, normal saline; DEX1 group, 0.3 ug/kg dexmedetomidine, and DEX2 group, 0.5 ug/kg dexmedetomidine. Oculocardiac reflex (OCR) events were recorded during surgery. PONV or postoperative vomiting (POV) was recorded for 24 hours in the ward. Pediatric anesthesia emergence delirium (PAED) scale and emergence agitation (EA) scale were recorded in the recovery room. Results : Intraoperative OCR was significantly reduced in DEX2 group (42%) as compared to that of Placebo group (68%) (p=0.0146). During the first 24 hours post-op, the overall incidence of PONV was significantly lower in DEX2 group (10%) than that of Placebo group (32%) (p=0.0142). There was no significant difference in POV among the three groups. PAED or EA scores among the three groups were similar during recovery time. Conclusion : Dexmedetomidine (0.5 ug/kg) reduced OCR and PONV without lengthening extubation time or recovery time in pediatric patients undergoing strabismus surgery.

scholarly journals Effect of dexmedetomidine on prevention of postoperative nausea and vomiting in pediatric strabismus surgery: A randomized controlled study

2019 ◽  
Author(s):  
shuangshuang li ◽  
Tingjie Liu ◽  
Junming Xia ◽  
Jie Jia ◽  
Wenxian Li
Keyword(s):  
Placebo Group ◽  
Postoperative Nausea ◽  
Recovery Time ◽  
Pediatric Patients ◽  
Postoperative Nausea And Vomiting ◽  
Strabismus Surgery ◽  
Nausea And Vomiting ◽  
Controlled Study ◽  
Extubation Time ◽  
Significant Difference

Abstract Background : Postoperative nausea and vomiting (PONV) are common side-effects following strabismus surgery. The present study aimed to compare the effects of different doses of dexmedetomidine (DEX) on PONV incidence in pediatric patients undergoing strabismus surgery. Methods : In this prospective randomized double-blinded study, 126 pediatric patients undergoing strabismus surgery were randomized into one of three groups: Placebo group, normal saline; DEX1 group, 0.3 ug/kg dexmedetomidine, and DEX2 group, 0.5 ug/kg dexmedetomidine. Oculocardiac reflex (OCR) events were recorded during surgery. PONV or postoperative vomiting (POV) was recorded for 24 hours in the ward. Pediatric anesthesia emergence delirium (PAED) scale and emergence agitation (EA) scale were recorded in the recovery room. Results : Intraoperative OCR was significantly reduced in DEX2 group (42%) as compared to that of Placebo group (68%) (p=0.0146). During the first 24 hours post-op, the overall incidence of PONV was significantly lower in DEX2 group (10%) than that of Placebo group (32%) (p=0.0142). There was no significant difference in POV among the three groups. PAED or EA scores among the three groups were similar during recovery time. Conclusion : Dexmedetomidine (0.5 ug/kg) reduced OCR and PONV without lengthening extubation time or recovery time in pediatric patients undergoing strabismus surgery.

Prospective evaluation of anesthetic protocols during pediatric ophthalmic surgery

2018 ◽  
Vol 29 (6) ◽  
pp. 606-614 ◽  
Author(s):  
Jean-Baptiste Ducloyer ◽  
Chloé Couret ◽  
Cécile Magne ◽  
Corinne Lejus-Bourdeau ◽  
Michel Weber ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Postoperative Nausea ◽  
Postoperative Nausea And Vomiting ◽  
Strabismus Surgery ◽  
Nausea And Vomiting ◽  
Ophthalmic Surgery ◽  
Oculocardiac Reflex ◽  
Locoregional Anesthesia ◽  
The Mean ◽  
Congenital Cataract Surgery

Purpose: To date, no protocol of anesthesia for pediatric ophthalmic surgery is unanimously recognized. The primary anesthetic risks are associated with strabismus surgery, including oculocardiac reflex, postoperative nausea and vomiting, and postoperative pain. Methods: This was a prospective, monocentric, observational study conducted in a tertiary pediatric ophthalmic unit. Our anesthetic protocol for strabismus surgery included postoperative nausea and vomiting prevention using dexamethasone and ondansetron. No drug-based prevention of oculocardiac reflex or local/locoregional anesthesia was employed. Results: A total of 106 pediatric ophthalmic surgeries completed between November 2015 and May 2016 were analyzed. The mean patient age was 4.4 (range: 0.2–7.3, standard deviation: 2.4) years. Ambulatory rate was 90%. Oculocardiac reflex incidence was 65% during strabismus surgery (34/52), 50% during congenital cataract surgery (4/8), 33% during intramuscular injection of botulinum toxin (1/3), and 0% during other procedures. No asystole occurred. Postoperative nausea and vomiting incidence was 9.6% after strabismus surgery (5/52) and 0% following the other procedures. One child was hospitalized for one night because of persistent postoperative nausea and vomiting. Postoperative pain generally occurred early on in the recovery room and was quickly controlled. Its incidence was higher in patients who underwent strabismus surgery (27%) than in those who underwent other procedures (9%). Conclusion: Morbidity associated with ophthalmic pediatric surgery is low and predominantly associated with strabismus surgery. The benefit–risk ratio and cost-effectiveness of oculocardiac reflex prevention should be questioned. Our postoperative nausea and vomiting rate is low, thanks to the use of a well-managed multimodal strategy. Early postoperative pain is usually well-treated but could probably be more effectively prevented.

Alfentanil Causes Less Postoperative Nausea and Vomiting than Equipotent Doses of Fentanyl or Sufentanil in Outpatients 

1999 ◽  
Vol 91 (6) ◽  
pp. 1666-1666 ◽  
Author(s):  
Stephan Langevin ◽  
Martin R. Lessard ◽  
Claude A. Trépanier ◽  
Jean-Pierre Baribault
Keyword(s):  
Postoperative Nausea ◽  
Randomized Study ◽  
Recovery Period ◽  
Plasma Concentrations ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Oxygen Mixture ◽  
Postanesthesia Care Unit ◽  
Outpatient Basis ◽  
Opioid Administration

Background The relative potencies of alfentanil, fentanyl, and sufentanil as a risk factor for postoperative nausea and vomiting have not been determined. They were compared in a randomized study designed to obtain equipotent plasma concentrations of these three opioids at the beginning of the recovery period. Methods The study included 274 patients treated on an outpatient basis. The steady state opioid plasma concentration providing a predicted 50% reduction of the minimum alveolar concentration of isoflurane was used to determine the relative potency of the opioids. The opioids were prepared in equal volumes at concentrations of alfentanil 150 microg/ml, fentanyl 50 microg/ml, and sufentanil 5 microg/ml and were administered in vol/kg. Anesthesia was induced in a blinded fashion with a bolus of the study opioid (0.05 ml/kg) and 4-6 mg/kg thiopental and was maintained with isoflurane (0.6-1%) in a nitrous oxide-oxygen mixture with a continuous infusion of the study opioid (0.06 ml x kg(-1) x h(-1)). If necessary, up to five additional boluses of opioid (0.02 ml/kg) could be given. This opioid administration protocol was tested by pharmacokinetic simulations. Results The incidence of postoperative nausea and vomiting was not different in the postanesthesia care unit, but in the ambulatory surgery unit it was significantly lower for alfentanil compared with fentanyl and sufentanil (12, 34, and 35%, respectively P < 0.005). Pharmacokinetic modeling showed that the end-anesthesia opioid plasma concentrations were approximately equipotent in the three groups. However, modeling does not support that the difference between groups in the postoperative period can be explained by a more rapid disappearance of alfentanil from the plasma. Conclusions Alfentanil, compared with approximately equipotent doses of fentanyl and sufentanil, is associated with a lower incidence of postoperative nausea and vomiting in outpatients.

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