Bhardwaj Neerja, Bala Indu, Kaur Charanjit, Chari Pramila
Postgraduate Institute of Medical Education and Research, Chandigarh, India.
J Pediatr Ophthalmol Strabismus. 2004 Mar-Apr;41(2):100-4. doi: 10.3928/0191-3913-20040301-10.
Children undergoing strabismus surgery have a high incidence of postoperative nausea and vomiting. Ondansetron plus dexamethasone is effective in reducing its incidence in many surgical procedures.
To examine the efficacy of ondansetron plus dexamethasone in children undergoing strabismus surgery.
A randomized, placebo-controlled, double blind study of 100 children 2 to 12 years old, in American Society of Anesthesiologists classes I and II, and undergoing strabismus surgery with the use of general anesthesia was conducted. Children received normal saline (n = 31), an injection of 0.15 mg/kg of ondansetron (n = 39), or an injection of 0.15 mg/kg of ondansetron and 0.2 mg/kg of dexamethasone (n = 30). Postoperatively, children were monitored for the number of emetic episodes, Steward recovery score, and need for a rescue antiemetic.
The incidence of vomiting was 64.5% in the group receiving saline, 33.3% in the group receiving ondansetron, and 10% in the group receiving ondansetron plus dexamethasone (P < .001). The incidence of early vomiting (0 to 4 hours) and the need for a rescue antiemetic were significantly lower in the groups receiving ondansetron (P < .01) and ondansetron plus dexamethasone (P < .001) compared with the group receiving saline; however, the former two groups were comparable in this regard. In the late postoperative period (4 to 24 hours), the incidence of vomiting and the need for a rescue antiemetic were not significantly different among the groups. Vomiting was significantly more severe in the group receiving saline compared with the groups receiving ondansetron and ondansetron plus dexamethasone at all times (P < .01 and P < .001, respectively). However, the latter two groups were comparable in this regard.
Ondansetron and ondansetron plus dexamethasone were equally effective in preventing early nausea and vomiting in children following strabismus surgery. However, the efficacy of dexamethasone in late postoperative nausea and vomiting could not be demonstrated. Further studies with a large population and different doses of dexamethasone may be warranted.
接受斜视手术的儿童术后恶心呕吐发生率较高。昂丹司琼联合地塞米松在许多外科手术中能有效降低其发生率。
探讨昂丹司琼联合地塞米松在接受斜视手术儿童中的疗效。
对100名年龄在2至12岁、美国麻醉医师协会分级为I级和II级且接受全身麻醉下斜视手术的儿童进行了一项随机、安慰剂对照、双盲研究。儿童分别接受生理盐水（n = 31）、0.15 mg/kg昂丹司琼注射（n = 39）或0.15 mg/kg昂丹司琼与0.2 mg/kg地塞米松注射（n = 30）。术后，对儿童的呕吐发作次数、Steward恢复评分及急救止吐药需求进行监测。
接受生理盐水组的呕吐发生率为64.5%，接受昂丹司琼组为33.3%，接受昂丹司琼联合地塞米松组为10%（P <.001）。与接受生理盐水组相比，接受昂丹司琼组（P <.01）和接受昂丹司琼联合地塞米松组（P <.001）的早期呕吐（0至4小时）发生率及急救止吐药需求显著更低；然而，前两组在这方面相当。在术后晚期（4至24小时），各组间呕吐发生率及急救止吐药需求无显著差异。在所有时间点，接受生理盐水组的呕吐均比接受昂丹司琼组和接受昂丹司琼联合地塞米松组严重得多（分别为P <.01和P <.001）。然而，后两组在这方面相当。
昂丹司琼及昂丹司琼联合地塞米松在预防儿童斜视手术后早期恶心呕吐方面同样有效。然而，地塞米松在术后晚期恶心呕吐中的疗效未能得到证实。可能需要进行更大规模人群及不同剂量地塞米松的进一步研究。
