This study evaluated the antiemetic efficacy, cost-effectiveness and clinical utility of prophylactic ondansetron and dexamethasone compared with placebo in the prevention of postoperative nausea and vomiting (PONV) in 135 children (2-15 yr, ASA I-II) undergoing strabismus repair. After induction with halothane and nitrous oxide in oxygen or i.v. thiopental, the children received i.v. dexamethasone 1 mg kg(-1) to a maximum of 25 mg, ondansetron 100 microg kg(-1) to a maximum of 4 mg or placebo (n=45). Episodes of PONV were recorded for the first 24 h after the operation. True outcome measures (parental satisfaction score, duration of stay in the postanaesthesia care unit and fast tracking time), therapeutic outcome measures (number needed to prevent (NNTP) PONV) and the cost to benefit a child with each drug were analysed. The incidence and severity of PONV in the first 24 h were significantly less in the dexamethasone and ondansetron groups than in the placebo group (P<0.05). The incidence (P=0.04) and severity (P=0.03) of PONV at the 6-24 h epoch were significantly less in the dexamethasone group than in the ondansetron group. Recovery time (P=0.07), fast tracking time (P=0.6), parental satisfaction scores (P=0.08) and NNTP PONV were comparable (NNTP=2) in both the ondansetron and the dexamethasone group. The cost to benefit a child with dexamethasone was approximately 22 times less than that of ondansetron.

SummaryWe have assessed the effect of two induction agents on tracheal intubating conditions after rocuronium 0.6 mg.kg À1 in unpremedicated patients undergoing simulated rapid sequence induction. Following pre-oxygenation, anaesthesia was induced with propofol up to 2.5 mg.kg À1 (n 35) or etomidate 0.3 mg.kg À1 (n 36), and further increments as required. After loss of verbal contact, cricoid pressure was applied and rocuronium was injected. Laryngoscopy was performed at 45 s and intubation attempted at 60 s after rocuronium had been given. Ninety-four per cent of patients in the propofol group had clinically acceptable (good or excellent) intubating conditions compared to only 75% in the etomidate group (p 0.025). Owing to coughing, one patient in the etomidate group could not be intubated on the first attempt. A greater pressor response also followed intubation after induction with etomidate. We conclude that etomidate and rocuronium alone cannot be recommended for intubation at 60 s under rapid sequence induction conditions. After a period of oxygenation an intravenous barbiturate followed immediately by a full dose of muscle relaxant have long been used to permit rapid tracheal intubation in the patient at risk of aspiration [1, 2]. Thiopentone and suxamethonium are traditionally used for this purpose. Rocuronium has been shown to be a suitable alternative to suxamethonium for rapid tracheal intubation [3]. Pharyngeal and laryngeal reflexes are more depressed by propofol than by other intravenous induction agents [4] and may create more favourable intubating conditions. Propofol is increasingly being used as the induction agent of choice for rapid tracheal intubation in patients who are haemodynamically stable [5]. The main problem concerning induction of anaesthesia with propofol is dose-related hypotension and this may preclude its use in the elderly and hypovolaemic patients [6][7][8][9].Of the current induction agents, etomidate causes the least haemodynamic disturbance and may be more suitable when cardiac stability is desirable [6, 7, 10]. We were interested to see if intubating conditions and cardiovascular changes under rapid sequence induction conditions were acceptable if anaesthesia was induced with etomidate and rocuronium, rather than with propofol and rocuronium. Patients and methodAfter obtaining approval from the hospital ethics committee and informed patient consent, we studied 71 adult patients aged 18-75 years, ASA grades I and II, undergoing elective surgery. Patients with potential airway problems were not studied. No patient had hepatic or renal impairment or was receiving any medication known to interact with neuromuscular blocking agents. Patients were unpremedicated and randomly allocated to receive either propofol or etomidate after a 3-min period of preoxygenation. The estimated induction dose in the propofol group was 2.5 mg.kg À1 , and 0.3 mg.kg À1 in the etomidate group. The agent was titrated over 30 s until verbal contact was lost. Further increments were given if required. H...

SummarySixty premedicated, ASA physical status I or II patients weighing . 25 kg scheduled for elective retinal detachment repair were randomly assigned to receive either peribulbar block with 10 ml of 0.25% bupivacaine (block group) or intravenous morphine 150 mg.kg 21 (morphine group), prior to the induction of general anaesthesia (n 30 in each group). Patients were evaluated for intraoperative oculocardiac reflex , peri-operative pain relief, recovery from anaesthesia and postoperative nausea and vomiting. Apart from significantly reducing the incidence of oculocardiac reflex (30% vs. 70%, p 0.0019), peribulbar bupivacaine also attenuated the severity of the reflex. Postoperative pain relief was superior in the block group. More block group patients had the maximum recovery score in the immediate postoperative period (80% vs. 27%, p , 0.0001) and they achieved complete recovery significantly faster than the morphine group (17.3 (14.7) min vs. 66.7 (29.7) min, p , 0.0001). The incidence (40% vs. 77%, p 0.004) and severity of postoperative nausea and vomiting were significantly less in the block group. In summary, peribulbar bupivacaine, when administered together with general anaesthesia, attenuated oculocardiac reflex, provided comparable intra-operative and superior postoperative analgesia, resulted in significantly earlier and better recovery from anaesthesia, and significantly reduced the incidence and severity of postoperative nausea and vomiting.

There were no complications related to the block. Peribulbar block appears to be a safe and useful analgesic technique for paediatric ophthalmic surgery.