Oculocardiac reflex and postoperative vomiting in paediatric strabismus surgery. A randomised controlled trial comparing four anaesthetic techniques
Identifieur interne : 002415 ( Main/Merge ); précédent : 002414; suivant : 002416Oculocardiac reflex and postoperative vomiting in paediatric strabismus surgery. A randomised controlled trial comparing four anaesthetic techniques
Auteurs : M. R. Tramer [Suisse] ; A. Sansonetti [Suisse] ; T. Fuchs-Buder [Suisse] ; K. Rifat [Suisse]Source :
- Acta anaesthesiologica scandinavica [ 0001-5172 ] ; 1998.
Descripteurs français
- Pascal (Inist)
- Wicri :
English descriptors
- KwdEn :
Abstract
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 . m-2 iv; (C) propofol induction and maintenance; (D) as (C) plus lignocaine 2 mg . kg-1 iv. All children received prophylactic atropine 0.02 mg . 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 numberneeded-to-treat was 5.5 (95% Cl 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% Cl 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 propofollignocaine showed no benefit on vomiting but significantly increased the risk of an OCR despite high-dose prophylactic atropine.
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Sansonetti</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Department of Ophthalmology, Geneva University Hospital</s1><s2>Geneva</s2><s3>CHE</s3><sZ>2 aut.</sZ></inist:fA14><country>Suisse</country><wicri:noRegion>Geneva</wicri:noRegion></affiliation></author><author><name sortKey="Fuchs Buder, T" sort="Fuchs Buder, T" uniqKey="Fuchs Buder T" first="T." last="Fuchs-Buder">T. Fuchs-Buder</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Division of Anaesthesiology, Department of Anaesthesiology, Pharmacology and Surgical Intensive Care, Geneva University Hospital</s1><s2>Geneva</s2><s3>CHE</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ></inist:fA14><country>Suisse</country><wicri:noRegion>Geneva</wicri:noRegion></affiliation></author><author><name sortKey="Rifat, K" sort="Rifat, K" uniqKey="Rifat K" first="K." last="Rifat">K. Rifat</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Division of Anaesthesiology, Department of Anaesthesiology, Pharmacology and Surgical Intensive Care, Geneva University Hospital</s1><s2>Geneva</s2><s3>CHE</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ></inist:fA14><country>Suisse</country><wicri:noRegion>Geneva</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">INIST</idno><idno type="inist">98-0077467</idno><date when="1998">1998</date><idno type="stanalyst">PASCAL 98-0077467 INIST</idno><idno type="RBID">Pascal:98-0077467</idno><idno type="wicri:Area/PascalFrancis/Corpus">000912</idno><idno type="wicri:Area/PascalFrancis/Curation">000A85</idno><idno type="wicri:Area/PascalFrancis/Checkpoint">000821</idno><idno type="wicri:doubleKey">0001-5172:1998:Tramer M:oculocardiac:reflex:and</idno><idno type="wicri:Area/Main/Merge">002415</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Oculocardiac reflex and postoperative vomiting in paediatric strabismus surgery. A randomised controlled trial comparing four anaesthetic techniques</title><author><name sortKey="Tramer, M R" sort="Tramer, M R" uniqKey="Tramer M" first="M. R." last="Tramer">M. R. Tramer</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Division of Anaesthesiology, Department of Anaesthesiology, Pharmacology and Surgical Intensive Care, Geneva University Hospital</s1><s2>Geneva</s2><s3>CHE</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ></inist:fA14><country>Suisse</country><wicri:noRegion>Geneva</wicri:noRegion></affiliation></author><author><name sortKey="Sansonetti, A" sort="Sansonetti, A" uniqKey="Sansonetti A" first="A." last="Sansonetti">A. Sansonetti</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Department of Ophthalmology, Geneva University Hospital</s1><s2>Geneva</s2><s3>CHE</s3><sZ>2 aut.</sZ></inist:fA14><country>Suisse</country><wicri:noRegion>Geneva</wicri:noRegion></affiliation></author><author><name sortKey="Fuchs Buder, T" sort="Fuchs Buder, T" uniqKey="Fuchs Buder T" first="T." last="Fuchs-Buder">T. Fuchs-Buder</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Division of Anaesthesiology, Department of Anaesthesiology, Pharmacology and Surgical Intensive Care, Geneva University Hospital</s1><s2>Geneva</s2><s3>CHE</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ></inist:fA14><country>Suisse</country><wicri:noRegion>Geneva</wicri:noRegion></affiliation></author><author><name sortKey="Rifat, K" sort="Rifat, K" uniqKey="Rifat K" first="K." last="Rifat">K. Rifat</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Division of Anaesthesiology, Department of Anaesthesiology, Pharmacology and Surgical Intensive Care, Geneva University Hospital</s1><s2>Geneva</s2><s3>CHE</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ></inist:fA14><country>Suisse</country><wicri:noRegion>Geneva</wicri:noRegion></affiliation></author></analytic><series><title level="j" type="main">Acta anaesthesiologica scandinavica</title><title level="j" type="abbreviated">Acta anaesthesiol. scand.</title><idno type="ISSN">0001-5172</idno><imprint><date when="1998">1998</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Acta anaesthesiologica scandinavica</title><title level="j" type="abbreviated">Acta anaesthesiol. scand.</title><idno type="ISSN">0001-5172</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Child</term><term>Comparative study</term><term>Complication</term><term>General anesthesia</term><term>Oculocardiac reflex</term><term>Postoperative</term><term>Strabismus</term><term>Surgery</term><term>Technique</term><term>Vomiting</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Anesthésie générale</term><term>Technique</term><term>Etude comparative</term><term>Strabisme</term><term>Chirurgie</term><term>Réflexe oculocardiaque</term><term>Vomissement</term><term>Complication</term><term>Postopératoire</term><term>Enfant</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Chirurgie</term><term>Enfant</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">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 . m<sup>-2</sup> iv; (C) propofol induction and maintenance; (D) as (C) plus lignocaine 2 mg . kg<sup>-1</sup> iv. All children received prophylactic atropine 0.02 mg . kg<sup>-1</sup> 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 numberneeded-to-treat was 5.5 (95% Cl 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% Cl 2.6-8). Conclusions: Thiopental-isoflurane-air/O<sub>2</sub>-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 propofollignocaine showed no benefit on vomiting but significantly increased the risk of an OCR despite high-dose prophylactic atropine.</div></front></TEI><affiliations><list><country><li>Suisse</li></country></list><tree><country name="Suisse"><noRegion><name sortKey="Tramer, M R" sort="Tramer, M R" uniqKey="Tramer M" first="M. R." last="Tramer">M. R. Tramer</name></noRegion><name sortKey="Fuchs Buder, T" sort="Fuchs Buder, T" uniqKey="Fuchs Buder T" first="T." last="Fuchs-Buder">T. Fuchs-Buder</name><name sortKey="Rifat, K" sort="Rifat, K" uniqKey="Rifat K" first="K." last="Rifat">K. Rifat</name><name sortKey="Sansonetti, A" sort="Sansonetti, A" uniqKey="Sansonetti A" first="A." last="Sansonetti">A. Sansonetti</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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