Nitrous oxide does not increase vomiting in children after myringotomy

Abstract

The aim of this study was to establish whether nitrous oxide has a clinically important effect on postoperative vomiting in children after myringotomy. We studied 320 healthy children of ages 0. Vomiting after general anaesthesia in children is common and may result in considerable postoperative morbidity.This vomiting is of multifactorial aetiology of which nitrons oxide is a possible contributing factor. Nitrous oxide may induce vomiting by causing bowel distension, decreasing gastric motility, increasing middle ear pressure or interacting with endogenous opioid receptors. ~-3Among adults undergoing minor gynaecological surgery, as little as a 10-14 min exposure to N202 has been associated with increased vomiting. 3 Overall, the resuits of adult investigations have been controversial. Both an emetic 2-5 and lack of effect 6-9 have been reported. There have been two paedia~c studies. Pandit et al. failed to demonstrate a difference in vomiting after tonsiUectomy (62% vs 76%). 6 In another study of 104 children, nitrous oxide increased vomiting after myringotomy from 4% to CAN J ANAESTH 1995 / 42:4 / pp 274-6

Are antiemetics cost-effective for children?

“…The incidence of POV in infancy is one quarter that in children 1-3 years of age which in turn is approximately one-half that in older children and adolescents. 3,4 This is similar to the data from Splinter et al 2 The explanation for the lower incidence of POV in infancy remains unclear. 3 However, what is clear is that the target age of children who develop POV is between 2 and 12 yr. POV also depends on the type of surgery; the incidence is greater after strabismus, tonsillectomy and adenoidectomy or orchidopexy surgery than it is after extremity or orthopaedic surgery.…”

Current Management of Vomiting After Tonsillectomy in Children

“…He found an increased rate of PONV with the use of N 2 O [72]. By contrast, Splinter et al demonstrated that N 2 O did not increase POV in children undergoing dental restoration [73] and myringotomy [74]. However, there have been no studies evaluating the effect of intraoperative use with N 2 O on POV in children undergoing tonsillectomy.…”

Lachgas

“…Eine Reihe kleinerer Studien [93,165,169,170] zeigte signifikant weniger PONV bei N 2 O-Verzicht; dagegen konnte in größeren Studien kein Unterschied nachgewiesen werden [39,108,144]. Die Interpretation der Studien wird zudem erschwert, da verschiedene Symptome (Übelkeit, Erbrechen, Würgen) gemessen wurden und nichtvergleichbare Patientenkollektive ausgewählt wurden.…”