Clinical management of postoperative vomiting after strabismus surgery in children.

摘要

Strabismus surgery is frequently performed operation in children. Despite improvements in anesthetic and surgical technique, postoperative vomiting (POV) after pediatric strabismus surgery is still being experienced by 41-88% when antiemetic prophylactics are not administered. Various antiemetics are currently available for the prevention and treatment of POV after strabismus surgery in children. Many studies have been conducted using therapeutic regimens to reduce POV. These drugs include traditional antiemetics (droperidol, metoclopramide, scopolamine, dixyradine, and dimenhydrinate), non-traditional antiemetics (dexamethasone, propofol, clonidine, midazolam, and lidocaine), and antiserotonins (ondansetron, granisetron, tropisetron, dolasetron, and ramosetron). Antiserotonins are more effective than traditional antiemetics, but these drugs are not entirely effective, perhaps because most of them act through the blockade on one type of receptor. Combination antiemetic therapy with antiserotonin (ondansetron, granisetron) plus droperidol or dexamethasone is highly effective for the prophylaxis against POV. Non-pharmacological techniques include acustimulation, acupressure, and acupuncture at P6 (Nei-Kuwan) point, Korean hand point (K-K9), and BL-10 (Tianzhu)-BL-11 (Dazhu)-GB-34 (Yanglinquan) points. For the treatment of established POV, antiserotonin (granisetron) is more effective than traditional antiemetics (droperidol, metoclopramide). Clildren undergoing strabismus surgery should be considered to receive these clinical strategies as mentioned above for the prevention and treatment of POV.