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ABSTRACTBACKGROUND AND OBJECTIVES: Strabismus surgery is a frequently performed pediatric ocular procedure. A frequently occurring major problem in patients receiving this treatment involves the oculocardiac reflex. This reflex is associated with an increased incidence of postoperative nausea, vomiting, and pain. The aim of this study was to investigate the effects of a sub-Tenon's block on the oculocardiac reflex, pain, and postoperative nausea and vomiting.METHODS: 40 patients aged 5-16 years with American Society of Anesthesiologists status I-II undergoing elective strabismus surgery were included in this study. Patients included were randomly assigned into two groups by using a sealed envelope method. In group 1 (n = 20), patients did not receive sub-Tenon's anesthesia. In group 2 (n = 20), following intubation, sub-Tenon's anesthesia was performed with the eye undergoing surgery. Atropine use, pain scores, oculocardiac reflex, and postoperative nausea and vomiting incidences were compared between groups.RESULTS: There were no significant differences between groups with regard to oculocardiac reflex and atropine use (p > 0.05). Pain scores 30 min post-surgery were significantly lower in group 2 than in group 1 (p < 0.05). Additional analgesic needed during the postoperative period was significantly lower in group 2 compared to group 1 (p < 0.05).CONCLUSIONS: In conclusion, we think that a sub-Tenon's block, combined with general anesthesia, is not effective and reliable in decreasing oculocardiac reflex and postoperative nausea and vomiting. However, this method is safe for reducing postoperative pain and decreasing additional analgesia required in pediatric strabismus surgery.
RESUMOJUSTIFICATIVA E OBJETIVO: A cirurgia de estrabismo é um procedimento oftalmológico comum em pediatria. Um grande problema que ocorre com frequência em pacientes submetidos a esse tratamento envolve o reflexo oculocardíaco. Esse reflexo está associado ao aumento da incidência de náusea, vômito e dor. O objetivo deste estudo foi investigar os efeitos do bloqueio subtenoniano sobre o reflexo oculocardíaco, a dor, a náusea e o vômito no período pós-operatório.MÉTODOS: Foram incluídos no estudo 40 pacientes entre 5-16 anos, estado físico ASA I-II, submetidos à cirurgia eletiva de estrabismo. Foram randomicamente alocados em dois grupos, com o método de envelope lacrado. No Grupo 1 (n = 20),pacientes não receberam bloqueio subtenoniano. No Grupo 2 (n = 20), após a intubação, o bloqueio subtenoniano foi feito no olho submetido à cirurgia. Uso de atropina, escores de dor, reflexo oculocardíaco e incidência de náusea e vômito foram comparados.RESULTADOS: Não houve diferença significativa entre os grupos em relação ao reflexo oculocardíaco e ao uso de atropina (p > 0,05). Os escores de dor em 30 minutos de pós-operatório foram significativamente menores no Grupo 2 do que no Grupo 1 (p < 0,05). A necessidade de analgésico adicional durante o período pós-operatório foi significativamente menor no Grupo 2 do que no Grupo 1 (p < 0,05).CONCLUSÕES: O bloqueio subtenoniano, em combinação com anestesia geral, não é eficaz e confiável para diminuir o reflexo oculocardíaco, bem como náusea e vômito pós-operatórios (NVPO). Porém, esse método é seguro para diminuir a dor no período pós-operatório e reduzir a analgesia adicional necessária em cirurgia de estrabismo pediátrico.
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Strabismus/surgery , Anesthesia, Local/methods , Pain, Postoperative/prevention & control , Reflex, Oculocardiac , Postoperative Nausea and Vomiting/prevention & controlABSTRACT
AIM: To observe the efficacy of ondansetron by intravenous injection at different time in preventing nausea and vomiting after pediatric strabismus surgery.METHODS: Totally 90 children aged 3 - 11y were randomly selected for pediatric strabismus surgery from June 2013 to August 2013 in our hospital. The ASA grade of all children were Ⅰ - II. Children were randomly divided into three groups with 30 cases each. Group A received intravenous drip of ondansetron 0. 1mg/kg before surgery. Group B received intravenous drip of ondansetron 0. 1mg/kg after surgery. Group C as control group was not given ondansetron. The number and severity of nausea and vomiting were observed within 24h after surgery. RESULTS: There were no statistical significance in patients' gender, weight, age, duration of anesthesia, ketamine dosage and vital signs intraoperative between the three groups ( P > 0. 05 ). The incidence rate of postoperative nausea and vomiting ( PONV) of group A and B were significantly lower than group C (P0. 05). CONCLUSION:Using ondansetron is effective and safe in preventing PONV before and at the end of the pediatric strabismus surgery, which can also improve safety and be lower cost. It is a worthy promoting antiemetic approach for eye surgery.
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BACKGROUND: This study was designed to compare the effects of anesthetic methods used recently on emergence delirium in pediatric strabismus surgery. METHODS: Two hundred and thirty two children, aged 2-10 years, undergoing strabismus surgery, were randomly assigned to one of eight groups; ketamine-desflurane (n = 30), ketamine-sevoflurane (n = 30), ketamine-propofol (n = 30), ketamine-remifentanil (n = 27), midazolam-desflurane (n = 28), midazolam-sevoflurane (n = 30), midazolam-propofol (n = 27), and midazolam-remifentanil (n = 30). Anesthesia was induced with ketamine 1.0 mg/kg or midazolam 0.15 mg/kg. Laryngeal mask airway (LMA) was placed with rocuronium 0.5 mg/kg. Anesthesia was maintained with desflurane 5-6 vol%, sevoflurane 2-3 vol%, propofol 7-8 mg/kg/hr, and remifentanil 0.5microgram/kg/min under N2O 66% in O2. Ventilation was controlled to maintain normocapnia. The status of emergence delirium (ED) was evaluated by a blinded observer until discharge from postanesthetic care unit. RESULTS: There was no differences in age, sex, weight, height, anesthetic time, and recovery time among the eight groups. ED occurred in 54 children (23.3%), but severe ED needed treatment was not occurred. Compared with ketamine group, midazolam group showed less incidence of ED. Propofol and remifentanil groups showed less incidence of ED compared with desflurane and sevoflurane groups. ED group was more younger and more temperamental compared with nonED group. CONCLUSIONS: Propofol or remifentanil anesthesia provided less incidence of ED compared with desflurane and sevoflurane in pediatric strabismus surgery.
Subject(s)
Child , Humans , Anesthesia , Anesthetics , Delirium , Incidence , Ketamine , Laryngeal Masks , Midazolam , Propofol , Strabismus , Temperament , VentilationABSTRACT
< 0.05). The incidence of emergence agitation was 17% in the subtenons lidocaine injection group, which was significantly lower than in the control group (36%) (P < 0.05). CONCLUSIONS: A lidocaine injection into the subtenons space reduces emergence agitation after sevoflurane anesthesia in pediatric strabismus surgery.