Abstract
The study was designed to compare the frequency and severity of postoperative vomiting in paediatric out-patients receiving controlled ventilation (IPPV) or breathing spontaneously (SV) during anaesthesia for strabismus repair. One hundred and twenty unpremedicated children (ages 2-12 years) were studied in a randomized fashion. After intravenous induction of anaesthesia and tracheal intubation, patients breathed halothane 1-1.5 per cent inspired and N2O 66 per cent in O2 spontaneously (n = 60), or received IPPV, halothane 0.5-1 per cent, N2O 66 per cent, and pancuronium 0.05 mg.kg-1, which was reversed with neostigmine and atropine (n = 60). The incidence of vomiting with SV was 50 per cent (95 per cent confidence limits: 34.5-65.5 per cent) compared with 40 per cent (24.5-55.5 per cent) with IPPV (p > 0.25). Patients in the SV group experiencing emesis had longer operations than those not vomiting (mean ± SEM = 1.5 ± 0,1 vs 1.2 ± 0.1 hours, p < 0.005). This was not the case with IPPV. There was no correlation between age, sex, duration of surgery, or number of extraocular muscles repaired, and frequency or severity of vomiting or time to discharge. No significant advantage was afforded by IPPV over SV in the present study.
Résumé
Cette étude était conçue afin de comparer la fréquence et sévérité du vomissement post-opératoire chez les patients pédiatriques externes admis pour correction de strabisme sous anesthésie générale en respiration spontanée (SV) ou ventilation contrôlée (IPPV). Cent vingt patients non prémédiqués âgés de 2 à 12 ans ont été étudiés ďune façon randomisée. Après ľinduction intraveineuse de ľanesthésie et ľintubation trachéale les patients ont reçu de ľhalothane 1-1.5 pour cent et protoxyde ďazote 66 pour cent avec O2 soit en respiration spontanée (n = 60), soit en ventilation contrôlée de ľhalothane 0.5-1 pour cent, protoxyde ďazote 66 pour cent et pancuronium 0.05 mg-kg-1, qui a été antagonisé avec la néostigmine et ľatropine (n = 60). Ľincidence de vomissement en ventilation spontanée était de 50 pour cent (95 pour cent limite de confiance: 34.5-65.5 pour cent) comparé à 40 pour cent (24.5-55.5 pour cent) avec IPPV (p > 0.25). Les patients du groupe SV ayant accusé des vomissements ont subi des opérations de plus longue durée que ceux qui n’en ont pas eus (movenne ± SEM = 1.5 ± 0.1 versus 1.2 ± 0.1 heures, p < 0.005). Ceci n’était pas le cas avec le groupe IPPV. Il n’y avait aucune corrélation avec ľâge, sexe, durée de la chirurgie ou le nombre de muscles extra-oculaires réparés avec la fréquence ou la sévérité des vomissements ou le temps du congé. Aucun avantage significatif n‘a acquis par la ventilation contrôlée comparativement à la ventilation spontanée dans la présente élude.
Article PDF
Similar content being viewed by others
References
Iwamoto K, Schwartz H. Antiemetic effect of droperidol after ophthalmic surgery. Arch Ophthalmol 1978; 96: 1378–9.
Weinstock SM, Flynn JT. Brief hospital admissions for pediatric strabismus surgery. Am J Ophthalmol 1975; 80: 525–9.
Abramowitz MD, Tae HO, Epstein BS, Ruttimann VE, Friendly DS. The antiemetic effect of droperidol following outpatient strabismus surgery in children. Anesthesiology 1983; 59: 579–83.
Lerman J, Eustis S, Smith DR. Effect of droperidol pretreatment on postanaesthetic vomiting in children undergoing strabismus surgery. Anesthesiology 1986; 65: 322–5.
Eustis S, Lerman J, Smith D. Droperidol pretreatment in children undergoing strabismus repair: the minimal effective dose. Can Anaesth Soc J 1986; 33: S115.
Hardy JF, Charest J, Girouard G, Lepage Y, Nausea and vomiting after strabismus surgery in preschool children. Can Anaesth Soc J 1986; 33: 57–62.
Dupre LJ, Stieglitz P. Extrapyramidal syndromes after premedication with droperidol in children. Br J Anaesth 1980; 52: 831–3.
Dyrberg V. Haloperidol (Serenase) in the prevention of postoperative nausea and vomiting. Acta Anaesthesiol Scand 1962; 6: 37–47.
Bellville JW, Bross IDJ, Howland WS. Postoperative nausea and vomiting. Anesthesiology 1960; 21: 186–93.
Bellville JW. Postanesthetic nausea and vomiting. Anesthesiology 1961; 22: 773–9.
Rose DK, Froese AB. The regulation of PaCO2 during controlled ventilation of children with a T-piece. Can Anaesth Soc J 1979; 26: 104–13.
Meakin G, Coates AL. An evaluation of rebreathing with the Bain system during anaesthesia with spontaneous ventilation. Br J Anaesth 1983; 55: 487–5.
Morrow GR. The assessment of nausea and vomiting: past problems, current issues, and suggestions for future research. Cancer 1984; 53: 2267–78.
Dixon WJ, Massey FJ. Introduction to Statistical Analysis. 3rd ed. New York: McGraw-Hill Book Co., 1969.
Swinscow TDV. Statistics at Square One. 2nd ed. London: British Medical Association, 1977.
Cohen J. Statistical Power Analysis for the Behavioural Sciences. Revised edition. New York: Academic Press, 1977.
Nikki P, Pohjda S. Nausea and vomiting after ocular surgery. Acta Ophthalmol 1972; 50: 525–30.
Smith JM. Post-operative vomiting in relation to anaesthetic time. Br Med J 1945; August: 217.
Steward DJ. Experiences with an outpatient anesthesia service for children. Anesth Analg 1973; 52: 877–80.
Fahy A, Marshall M. Postanaesthetic morbidity in outpatients. Br J Anaesth 1969; 41: 433–8.
Rita L, Goodarzi M, Seleny F. Effect of low dose droperidol on post-operative vomiting in children. Can Anaesth Soc J 1981; 28: 259–62.
Purkis IE. Factors that influence post-operative vomiting. Can Anaesth Soc J 1964; 11: 335–53.
Palazzo MGA, Strunin L. Anaesthesia and emesis. I: Etiology. Can Anaesth Soc J 1984; 31: 178–87.
Palazzo MGA, Strunin L. Anaesthesia and emesis. II: Prevention and management. Can Anaesth Soc J 1984; 31: 407–15.
Riding JE. Post-operative vomiting. Proc Roy Soc Med 1960; 53: 671–7.
Janhunen L, Tammisto T. Postoperative vomiting after different modes of general anesthesia. Ann Chir Gyn Fenn 1972; 61: 152–9.
Clarke RSJ, Dundee JW, Love WJ. Studies of drugs given before anaesthesia. VIII. Morphine 10 mg alone and with atropine or hyoscine. Br J Anaesth 1965; 37: 772–7.
Anderson SM. In Evans FT and Gray TC (eds). General Anaesthesia, 2nd ed. London: Buttenvorth, 1965.
Karhunen U, Nilsson E, Brander P. Comparison of four non-depolarizing neuromuscular blocking drugs in the suppression of the oculocardiac reflex during strabismus surgery in children. Br J Anaesth 1985; 57: 1209–12.
Deacock ARC, Oxer HF. The prevention of reflex bradycardia during ophthalmic surgery. Br J Anaesth 1962; 34: 451–7.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Walsh, C., Smith, C.E., Ryan rn, B. et al. Postoperative vomiting following strabismus surgery in paediatric outpatients: spontaneous versus controlled ventilation. Can J Anaesth 35, 31–35 (1988). https://doi.org/10.1007/BF03010541
Issue Date:
DOI: https://doi.org/10.1007/BF03010541