STRABISMUS SURGERY IS NO ADDITIONAL RISK FACTOR FOR POSTOPERATIVE VOMITING IN CHILDREN COMPARED TO ENT-SURGERY

Abstract

S23 BACKGROUND: Strabismus surgery in children is reported to be associated with an extremely high incidence of postoperative nausea and vomiting (PONV) [1]. It has been suggested that this is related to an "oculo-emetic reflex", arising from extraocular muscle stimulation [2]. Recent data have shown that the impact of the type of surgery for postoperative vomiting (POV) is relatively small [3]. Therefore, we examined whether the incidences of POV after strabismus surgery is higher compared to ENT surgery in children. METHODS: With approval of the local ethics committee 406 ASA I-III children between 4-14 years received general anesthesia for strabismus surgery (n=170), adenotonsillectomy (n=100), tympanoplasty (n=86) and other types of ENT surgery (n=50). The patients were randomly stratified to one of four groups of anesthesia. Anaesthesia was induced with low dose opioids and thiopentone or propofol, and maintained with isoflurane, enflurane, sevoflurane or propfol in N2 O/O2 2:1. Antiemetics were given due to stratification (Droperidol, metoclopramide, tropisetron, dimenhydrinat or placebo). Emetic episodes (retching or vomiting) were recorded over 25 hours according to a standardized protocol. Statistics were performed using chi-square test and logistic regression analysis, with p<0.05 considered statistically significant. RESULTS: There were no significant differences among the groups for sex, PONV and motion sickness in the history, antiemetics, opioids and anesthetics, but for age. Therefore, additionally a logistic regression analysis was performed, revealing only motion sickness as the main risk factor for POV. The incidence of POV in the four groups did not differ significantly. (Table 1)Table 1DISCUSSION: In contrast to previous studies our data suggest that strabismus surgery in children is not associated with an increased incidence of POV compared to ENT surgery. Therefore, we conclude that strabismus surgery is no additional risk factor for POV compared to ENT surgery.