PREVENTION OF VOMITING AFTER STRABISMUS SURGERY IN CHILDREN

Abstract

S419 For children postoperative vomiting is a common complication after strabismus surgery [1]. The combination of dexamethasone and ondansetron decreases vomiting after strabismus surgery, while dexamethasone alone decreases vomiting after tonsillectomy in children [2,3]. We compared the effect of dexamethasone alone to ondansetron plus dexamethasone on postoperative vomiting among children undergoing strabismus surgery. METHODS: With Ethics Committee approval and parental consent healthy children of ages 2-14 yr undergoing strabismus surgery were entered into this randomized, blocked and stratified study. Patients were administered 0.5 mg/kg midazolam p.o. 20-30 min preoperatively when indicated. The patients had an IV induction with 2.5-3.5 mg/kg propofol or an inhalation induction of anesthesia with halothane and N2 O. Mivacurium, 0.2 mg/kg, was administered if indicated. All patients were given 20 [micro sign]g/kg atropine IV. After induction of anesthesia the study drugs were administered in a double-blind fashion. Both groups received 150 [micro sign]g/kg dexamethasone IV. Group D patients received placebo and Group OD received 50 [micro sign]g/kg of ondansetron IV. Anesthesia was maintained with halothane and N2 O. Postoperative fluid, vomiting and pain management were standardized. Patients were followed for 24 hours. Data were compared with t-tests and Chi-square analysis. RESULTS: We studied 133 patients with 66 patients in the OD Group. The groups had similar demographic data. The overall incidence of vomiting was 21% in Group D and 9% in Group OD, P<0.05. Each episode of vomiting increased the in-hospital length of stay by 29 min, P<0.001. The average cost of supplementation of dexamethasone with ondansetron was $3.80 US per patient. CONCLUSION: With a remarkably low incidence of vomiting of 9%, the combination of dexamethasone plus a low-dose of ondansetron more effectively decreased vomiting after strabismus surgery in children when compared to dexamethasone alone.