Nausea and Vomiting After Strabismus-Surgery: A Randomized Comparison of Isoflurane, Enflurane, Sevoflurane and Propofol

Abstract

Abstract:Background: Previous studies reported that propofol anesthesia is an effective means of preventing postoperative nausea and vomiting (PONV) after different types of surgeries. The present analysis of a large antiemetic trial is intend to compare propofol versus isoflurane, enflurane or sevoflurane with respect to the incidences of PONV after strabismus surgery.Methods: 238 ASA I -III inpatients, aged 4-65 years were randomly assigned to receive either isoflurane (group I, n = 60), enflurane (group E, n = 59), sevoflurane (group S, n = 59) or propofol (group P, n = 60) for maintenance as a subgroup of a larger trial of factorial design to investigate interventions to reduce PONV. After opioid application, patients in the inhalational groups (group I, E and S) had anesthesia induced with thiopental, those in group P received propofol for induction. Tracheal intubation was facilitated with succinylcholine. Patients were ventilated with N 2 O/O 2 2:1. Incidence and severity of PONV as well as the need for antiemetic rescue treatment were studied during the first 24 hours after anesthesia. Paracetamol and tramadol was given to treat postoperative pain.Results: There were no significant differences between study groups with respect to patient demographics and risk factors for postoperative nausea and vomiting. Nausea was reported by 43%, 41%, 42% and 22% of patients in groups I, E, S and P, respectively (P = 0.043). The incidence of vomiting was 40%, 46%, 34% and 18% in groups I, E, S and P, respectively (P = 0.011). Conclusion:Patients anesthetized with propofol showed a significantly lower incidence of nausea and vomiting compared to volatile anesthetics, while there was no significant differences in emetogenicity between the volatile anesthetics.

The Effect of Different Anesthesia Techniques on Strabismus Surgery: A Prospective Observational Study

“…It has been postulated to be an antagonist at the 5HT3 receptor. Other reports suggest that the anti-emetic effect of propofol is due to modulation of the subcortical pathways (16,17). In many recent reports, propofol should be the first choice among anesthetic agents, especially since it prevents the development of PONV in strabismus surgery of pediatric patients (18).…”

Anaesthetic considerations for strabismus surgery in children and adults

“…46 However, it is associated with an increased incidence of emergence agitation (sevoflurane 33% versus halothane 0%). 67 Maintenance of anaesthesia with propofol, compared with volatile anaesthetic agents, reduces emergence agitation 68 and PONV 69 but increases the incidence of OCR 49 in strabismus surgery.…”

“…Ophthalmic regional blockade inhibits the sensory afferent pathway and reduces the incidence of PONV. 48 Adequate hydration with intravenous crystalloid (15–30 ml/kg), 85 maintenance of anaesthesia with propofol, 69 use of topical LA 48 and minimum opioid usage, 86 have also been reported to reduce the incidence of PONV.…”