Vomito después de adenotonsilectomía en niños: comparación entre inducción con propofol y mantenimiento con sevofluorano-óxido nitroso y TIVA con propofol-remifentanil

Vomito después de adenotonsilectomía en niños: comparación entre inducción con propofol y mantenimiento con sevofluorano-óxido nitroso y TIVA con propofol-remifentanil Vomiting after a pediatric adenotonsillectomy: comparison between propofol induced sevoflurane-nitrous oxide maintained anesthesia and TIVA with propofol-remifentanil. Chung JH, Kim YH, Ko YK, Lee SY, Nam YT, Yoon SH. Department of Anesthesiology and Pain Medicine, Eulji University School of Medicine, Daejeon, Korea. Korean J Anesthesiol. 2010 Sep;59(3):185-9. Epub 2010 Sep 20 Abstract BACKGROUND: Anesthesia methods and drugs affect postoperative nausea and vomiting. Propofol is known to have antiemetic effects. We compared the incidence of postoperative vomiting (POV) in children undergoing an adenotonsillectomy; anesthesia in one group was induced with propofol and maintained with sevoflurane and nitrous oxide, and the other group received total intravenous anesthesia (TIVA) with propofol-remifentanil. METHODS: Ninety children, ASA physical status I, were assigned randomly to one of two groups. In the PSN group, anesthesia was maintained with 2-3 vol% sevoflurane and 50% nitrous oxide. In the PR group, anesthesia was maintained with 10 mg/kg/h propofol and 0.25 µg/kg/min remifentanil. In both groups, anesthesia was induced with 0.5 µg /kg remifentanil and 2 mg/kg propofol. The incidence of POV and the need for rescue antiemetics were assessed in the postanesthesia care unit at 6, 12, and 24 hours postoperatively. RESULTS: The total incidence of POV was not significantly different between the groups; POV occurred in eight (17.7%) and three (6.7%) children in the PSN and PR groups, respectively. Postoperative frequency of retching in the recovery room was significantly higher in the PSN group, with four children (8.9%) in the PSN group compared to none (0%) in the PR group (P = 0.041). The frequency of POV 24 hrs after exiting the recovery room tended to be higher in the PSN group than the PR group, but no statistically significant difference was observed. CONCLUSIONS: If the development of POV in the early anesthetic recovery phase of children undergoing adenotonsillectomy is adequately prevented, propofol-induced anesthesia maintained with sevoflurane-nitrous oxide is as safe as TIVA with propofol-remifentanil   Artículo en PDF Estudio prospectivo de vomito postoperatorio en niños sometidos a diferentes procedimientos operatorios bajo anestesia general  A Prospective Study of Postoperative Vomiting in Children Undergoing Different Surgical Procedures under General Anaesthesia Jaya Choudhary1, S Bano2, Mohib Ahmed3, M N Zaidi4 Indian Journal of Anaesthesia 2008; 52 (2): 159-163 Summary To identify the risk factors associated with postoperative vomiting (POV) in paediatric population undergoing common surgeries. The risk factors studied for association with POV were age >5 years, female gender, previous history of POV/motion sickness, type of surgery and duration of anaesthesia >45 min. A total of 100 ASA grade I and II patients of either sex aged between 2-12 years undergoing elective surgical procedures were screened for the study. All patients underwent similar anaesthesia protocol and received two antiemetic agents (ondansetron 0.05mg.kg-1 and dexamethasone 0.15mg.kg-1) in premedication. The patients were observed for 24 hours postoperatively for the incidence of vomiting, number of times rescue antiemetic given and any adverse reaction to antiemetic. Overall 34% patients (34/100) developed POV of which 26 had only one episode and 8 patients had 2 episodes during first 24 h. Incidence of POV was 13% (13/100) in first 4 h whereas it was 29% (29/100) in late postoperative period. In early post operative period, POV was not associated significantly with any predicted risk factors. However, age>5years, duration of anaesthesia>45 minutes and history of motion sickness/POV were significantly associated in late postoperative period(4-24h). Female gender and type of surgery were not associated with increased POV. The combination antiemetic effectively prevented POV in early postoperative period (0-4h) only but not in late postoperative period (0-24h). Artículo en PDF

Atentamente Dr. Enrique Hernández-Cortez Anestesiología y Medicina del Dolor www.anestesia-dolor.org