Oculocardiac reflex and postoperative vomiting in paediatric strabismus surgery. A randomised controlled trial comparing four anaesthetic techniques.
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.
Tramèr
M R
MR
Department of Anaesthesiology, Pharmacology and Surgical Intensive Care, Geneva University Hospital, Switzerland.
Sansonetti
A
A
Fuchs-Buder
T
T
Rifat
K
K
D000293:Adolescent; D015760:Alfentanil / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000768:Anesthesia, General / Q000379:methods*; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage; D000932:Antiemetics / Q000008:administration & dosage / Q000627:therapeutic use; D001285:Atropine / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D017558:Elective Surgical Procedures; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007275:Injections, Intravenous; D007530:Isoflurane / Q000008:administration & dosage; D008012:Lidocaine / Q000008:administration & dosage; D009184:Mydriatics / Q000627:therapeutic use; D017294:Ondansetron / Q000008:administration & dosage / Q000627:therapeutic use; D011183:Postoperative Complications / Q000209:etiology* / Q000517:prevention & control; D015742:Propofol / Q000008:administration & dosage; D012024:Reflex, Oculocardiac / Q000187:drug effects / Q000502:physiology*; D012307:Risk Factors; D013285:Strabismus / Q000601:surgery*; D013874:Thiopental / Q000008:administration & dosage; D014839:Vomiting / Q000209:etiology* / Q000517:prevention & control
D000701:Analgesics, Opioid; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D000932:Antiemetics; D009184:Mydriatics; D015760:Alfentanil; D017294:Ondansetron; D001285:Atropine; D008012:Lidocaine; D007530:Isoflurane; D013874:Thiopental; D015742:Propofol