Kraus G B, Giebner M, Palackal R
Institut für Anaesthesiologie, Universität Erlangen-Nürnberg.
Anaesthesist. 1991 Feb;40(2):92-5.
Children recovering from anaesthesia for strabismus surgery are particularly prone to nausea and vomiting as a result of intraoperative vagus irritation. Besides being disturbing to the patient, vomiting can be dangerous during emergence from anesthesia and can result in delayed discharge. Droperidol is a powerful antiemetic drug that has been shown to reduce the incidence and severity of postoperative nausea and vomiting in pediatric strabismus patients, although the best timing for administration is not clear. MATERIAL AND METHODS. We compared three randomized groups totalling 61 patients. Droperidol 0.075 mg/kg i.v. was given either at induction of anesthesia after intubation (n = 20) or during the last muscle suture (n = 21). The third group received no antiemetic treatment. The patients' ages ranged from 3 to 14 years (mean 5.9 +/- 2.84 years). There was no difference in age or sex between the three groups. Anesthesia was standardized with rectal midazolam premedication, atropine, thiopental, succinylcholine, O2/N2O = 1:2, enflurane, intubation, and a gastric tube. RESULTS. Nausea, retching, or vomiting occurred in 2/20 children (10%) given droperidol preoperatively, 4/21 children (19%) with droperidol during the operation, and 9/20 children (45%) with no antiemetic treatment. The difference between groups I and III was significant (p less than 0.05). Comparison of groups II and III and groups I and II showed no statistical significance. Operation time was similar in each group and there was no delay in time of extubation. In each group 1 case of hypotension occurred. No child showed extrapyramidal symptoms. The lower incidence of vomiting in all study groups compared to the literature is thought to be due to three factors: (1) emptying the stomach at the end of the operation by a gastric tube, which is removed before extubation; (2) avoidance of opioids; (3) surgical procedure being done by a very experienced surgeon in 57/61 children (12 vomiting versus 45 not vomiting) in contrast to 3/4 children vomiting postoperatively after surgery by a less experienced surgeon. CONCLUSIONS. We recommend preoperative droperidol 75 micrograms/kg i.v. as the best prophylaxis of postoperative emesis without severe side effects in pediatric strabismus surgery.
斜视手术麻醉苏醒期的儿童，由于术中迷走神经受刺激，特别容易发生恶心和呕吐。呕吐不仅会让患者不适，在麻醉苏醒期还可能很危险，导致出院延迟。氟哌利多是一种强效止吐药，已证明可降低小儿斜视患者术后恶心和呕吐的发生率及严重程度，但其最佳给药时机尚不清楚。材料与方法。我们比较了三组共61例患者。静脉注射0.075mg/kg氟哌利多，一组在插管后麻醉诱导时给药（n = 20），另一组在最后一针肌肉缝合时给药（n = 21）。第三组不进行止吐治疗。患者年龄在3至14岁之间（平均5.9±2.84岁）。三组患者的年龄和性别无差异。麻醉采用直肠咪达唑仑预处理、阿托品、硫喷妥钠、琥珀酰胆碱、O2/N2O = 1:2、恩氟烷、插管及胃管进行标准化操作。结果。术前给予氟哌利多的20例儿童中有2例（10%）出现恶心、干呕或呕吐，术中给予氟哌利多的21例儿童中有4例（19%）出现，未进行止吐治疗的20例儿童中有9例（45%）出现。第一组和第三组之间的差异有统计学意义（p＜0.05）。第二组与第三组以及第一组与第二组之间的比较无统计学意义。每组手术时间相似，拔管时间无延迟。每组均有1例发生低血压。无儿童出现锥体外系症状。与文献报道相比，所有研究组呕吐发生率较低被认为有三个因素：（1）手术结束时通过胃管排空胃内容物，拔管前拔除胃管；（2）避免使用阿片类药物；（3）57/61例儿童（12例呕吐，45例未呕吐）由经验丰富的外科医生进行手术，相比之下，经验较少的外科医生手术后3/4例儿童术后呕吐。结论。我们建议静脉注射75微克/千克氟哌利多作为小儿斜视手术术后呕吐的最佳预防措施，且无严重副作用。
