Postoperative nausea and vomiting after Faden operation.
OBJECTIVE
The purpose of this study was to evaluate the antiemetic effect of prophylactic dimenhydrinate application prior to Faden operation and to compare the incidence of PONV between bimedial Faden operation (BMF) and horizontal recess-resect procedure (R&R).


METHODS
Ninety-nine children (4-10 years) scheduled for BMF were included in this prospective double-blind study. Midazolam (0.5 mg/kg body weight, BW) was administered orally for premedication 30 min before induction of anesthesia. Additionally, children weighing >/=23 kg received either dimenhydrinate suppositories or placebo. The placebo group was compared with 148 children who underwent R&R surgery without antiemetic prophylaxis during the same period. Anesthesia was induced with thiopentone (5-10 mg/kg BW) and vecuronium (0.1 mg/kg BW) bromide and maintained with halothane (1-2 vol%) in N(2)O/O(2) (65/35 vol%). Age, height, weight, and incidence of oculocardiac reflex were documented. PONV was classified into "no vomiting", "vomiting without therapy", and "vomiting requiring rescue medication". In the latter case dimenhydrinate was given again. The chi-square test was used for statistical analysis.


RESULTS
Forty-eight patients received placebo, while 51 received dimenhydrinate. No differences between any groups were observed concerning age, height, weight, and incidence of oculocardiac reflex. Compared to R&R surgery, PONV requiring rescue medication occurred significantly more frequently after BMF (45% vs 23% after R&R). PONV after BMF was significantly less severe in the dimenhydrinate group than in the placebo group. The total incidence of PONV after BMF, however, was not significantly reduced.


CONCLUSIONS
The high incidence of PONV after BMF can be explained by the greater invasiveness of BMF than R&R surgery. PONV requiring antiemetic rescue medication can be reduced by preoperative administration of dimenhydrinate suppositories.
Welters
I D
ID
Department of Anaesthesiology and Operative Intensive Care, Rudolf-Buchheim-Strasse 7, D-35385 Giessen, Germany. Ingeborg.D.Welters@chiru.med.uni-giessen.de
Graef
M
M
Menges
T
T
Beikirch
C
C
Kaufmann
H
H
Hempelmann
G
G
D000772:Anesthesia, Local / Q000379:methods; D000932:Antiemetics / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004111:Dimenhydrinate / Q000008:administration & dosage / Q000627:therapeutic use*; D004311:Double-Blind Method; D006801:Humans; D015994:Incidence; D009801:Oculomotor Muscles / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures / Q000009:adverse effects*; D020250:Postoperative Nausea and Vomiting / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D013285:Strabismus / Q000601:surgery*; D013488:Suppositories; D013536:Suture Techniques
D000932:Antiemetics; D013488:Suppositories; D004111:Dimenhydrinate