Anesthetic techniques and postoperative emesis in pediatric strabismus surgery.
OBJECTIVE
Postoperative emesis after pediatric strabismus surgery continues to be a problem, despite the use of antiemetics. The purpose of this study was to identify an anesthetic technique associated with the lowest incidence of vomiting after pediatric strabismus surgery.


METHODS
A prospective, randomized, double-blind study was conducted to evaluate the effect of intravenous fentanyl, meperidine, or peribulbar block with propofol infusion on emesis in 105 pediatric patients undergoing strabismus surgery. Anesthesia was maintained with nitrous oxide, oxygen, and propofol infusion. Ketorolac 1.0 mg/kg -1 intramuscular was administered to all patients after induction. Patients were given either a peribulbar block, intravenous fentanyl 2 microg/kg -1 , or intravenous meperidine 1mg/kg -1 for perioperative analgesia. The emesis scores were observed for the first 24 hours postoperatively.


RESULTS
The incidence of emesis was significantly lower (1 of 35; 2.9%) in the peribulbar group compared with the meperidine group (9 of 35; 25.6%) (P <.01) in the first 24 hours. The fentanyl group had a higher incidence of postoperative vomiting (4 of 35; 11.4%) than did the peribulbar group; the difference, however, was not statistically significant.


CONCLUSIONS
Among the three techniques, peribulbar block with propofol-based anesthesia is the technique with the lowest incidence of postoperative emesis. Fentanyl-propofol is an equally acceptable alternative; however, meperidine-propofol is associated with a high incidence of postoperative emesis.
Chhabra
Anjolie
A
Deparment of Anesthesiology and Intensive Care, Dr. Rajendra Prasad Eye Centre, All India Institute of Medical Sciences, New Dehli, India. anjolie5@hotmail.com
Pandey
Rashmi
R
Khandelwal
Mamta
M
Subramaniam
Rajeshwari
R
Gupta
Surbhi
S
D000758:Anesthesia / Q000009:adverse effects* / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008614:Meperidine / Q000009:adverse effects / Q000627:therapeutic use; D009407:Nerve Block / Q000009:adverse effects; D020250:Postoperative Nausea and Vomiting / Q000139:chemically induced* / Q000517:prevention & control; D011446:Prospective Studies; D013285:Strabismus / Q000188:drug therapy / Q000601:surgery*
D008614:Meperidine; D005283:Fentanyl