Tramèr M R, Sansonetti A, Fuchs-Buder T, Rifat K
Department of Anaesthesiology, Pharmacology and Surgical Intensive Care, Geneva University Hospital, Switzerland.
Acta Anaesthesiol Scand. 1998 Jan;42(1):117-23. doi: 10.1111/j.1399-6576.1998.tb05091.x.
Oculocardiac reflex (OCR) and postoperative vomiting are major complications of paediatric strabismus surgery.
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 x m(-2) i.v.; (C) propofol induction and maintenance; (D) as (C) plus lignocaine 2 mg x kg(-1) i.v. All children received prophylactic atropine 0.02 mg x kg(-1) and alfentanil. Nitrous oxide was omitted.
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 number-needed-to-treat was 5.5 (95% CI 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% CI 2.6-8).
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 propofol-lignocaine showed no benefit on vomiting but significantly increased the risk of an OCR despite high-dose prophylactic atropine.
眼心反射（OCR）和术后呕吐是小儿斜视手术的主要并发症。
将住院接受择期斜视手术的儿童（3 - 16岁）随机分为四种麻醉技术组：（A）硫喷妥钠诱导、异氟烷维持；（B）同（A）加静脉注射昂丹司琼5 mg·m⁻²；（C）丙泊酚诱导和维持；（D）同（C）加静脉注射利多卡因2 mg·kg⁻¹。所有儿童均接受预防性阿托品0.02 mg·kg⁻¹和阿芬太尼。未使用氧化亚氮。
分析了157名儿童的数据。硫喷妥钠 - 异氟烷麻醉术后6小时和24小时内呕吐的累积发生率分别为26%和46%。加用昂丹司琼后，发生率分别降至8%和33%。仅在6小时内这种改善具有显著意义；需治疗人数为5.5（95%可信区间2.9 - 46）。丙泊酚与硫喷妥钠 - 异氟烷无差异。丙泊酚加用利多卡因无益处。与异氟烷（14%）相比，丙泊酚麻醉时OCR风险显著增加（发生率40%）；伤害需治疗人数为3.9（95%可信区间2.6 - 8）。
硫喷妥钠 - 异氟烷 - 空气/O₂ - 阿芬太尼导致呕吐风险中等。加用昂丹司琼显著降低了这种风险，但术后早期每治疗6名儿童才有1名获益。丙泊酚及丙泊酚 - 利多卡因对呕吐无益处，但尽管使用了高剂量预防性阿托品，仍显著增加了OCR风险。
