Incidence of vomiting in susceptible children under regional analgesia with two different anaesthetic techniques.
BACKGROUND
Postoperative vomiting (POV) is a frequent side-effect of paediatric surgery and a leading cause of unplanned admission. Many antiemetic drugs have been studied, but less attention has been given to the effects on POV of the anaesthetic technique adopted. The aim of this study was to compare two different anaesthetic techniques in children under regional analgesia at risk for POV.


METHODS
We studied 135 children suffering from motion sickness or with a previous history of POV. The patients were randomized to receive inhalation anaesthesia (group S) with sevoflurane by LMA or intravenous (i.v.) anaesthesia with ketamine and propofol (group P). All the patients were treated with an ilio-inguinal block after induction of anaesthesia. Postoperatively, the children were followed by the nursing staff and by their parents, none of whom were aware of the anaesthesia technique used.


RESULTS
A significant decrease was observed in the incidence of early (0-6 h) and delayed (6-24 h) POV in those children who received i.v. sedation. There was no difference between the two groups in the level of analgesia either at the end of surgery or 2 h postoperatively.


CONCLUSIONS
Anaesthesia based on propofol and ketamine is better than inhalation anaesthesia with sevoflurane by LMA for reducing POV in children at risk under an ilio-inguinal block. Tailoring the anaesthetic to the specific needs of children susceptible to POV should be considered before resorting to the routine use of expensive antiemetic prophylaxis.
Department of Anaesthesia and Intensive Care, IRCCS Istituto per l'Infanzia Burlo Garofolo, Trieste, Italy. sarti@burlo.trieste.it
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Sarti
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Busoni
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Dell'Oste
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Bussolin
D000765:Anesthesia, Conduction / Q000379:methods*; D000778:Anesthetics, Dissociative; D018685:Anesthetics, Inhalation / Q000009:adverse effects; D018686:Anesthetics, Intravenous; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation; D004198:Disease Susceptibility; D006552:Hernia, Inguinal / Q000601:surgery; D006801:Humans; D006993:Hypnotics and Sedatives; D007223:Infant; D007649:Ketamine; D017214:Laryngeal Masks; D008297:Male; D008738:Methyl Ethers; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control*; D015742:Propofol; D000077149:Sevoflurane; D016037:Single-Blind Method; D006848:Testicular Hydrocele / Q000601:surgery
D000778:Anesthetics, Dissociative; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D006993:Hypnotics and Sedatives; D008738:Methyl Ethers; D000077149:Sevoflurane; D007649:Ketamine; D015742:Propofol