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Effect of midazolam, dexamethasone and their combination on the prevention of nausea and vomiting following strabismus repair in children

  • W. Riad (a1), R. Altaf (a2), A. Abdulla (a2) and H. Oudan (a3)

Summary

Background

Postoperative nausea and vomiting is a common complication following strabismus surgery. This randomized and double-blind study was designed to evaluate the efficacy of midazolam alone or in combination with dexamethasone in reducing the incidence of postoperative nausea and vomiting in children undergoing strabismus repair.

Methods

One hundred ASA I children, aged 4–12 yr, scheduled to undergo elective strabismus surgery, were enrolled. No premedication was given. Anaesthesia was induced with sevoflurane, nitrous oxide and oxygen. After induction, fentanyl 2 μg kg−1 and cisatracurium 0.1 mg kg−1 were administered and an endotracheal tube was inserted. After induction of anaesthesia and before start of surgery, patients were randomly allocated into one of four groups of 25 children each to receive placebo, midazolam 50 μg kg−1, dexamethasone 0.5 mg kg−1 or a combination of midazolam 50 μg kg−1 and dexamethasone 0.5 mg kg−1. Episodes of nausea, and retching and vomiting were recorded during the first 24 h after surgery.

Results

The incidence of postoperative nausea was 48%, 32%, 12% and 0% with placebo, dexamethasone, midazolam and the midazolam–dexamethasone combination, respectively. The incidence of vomiting was 52% and 32% with placebo and dexamethasone, respectively; no child vomited with midazolam alone, or with the midazolam–dexamethasone combination.

Conclusion

Prophylactic midazolam with or without dexamethasone reduces the incidence of PONV in children undergoing strabismus repair.

Copyright

Corresponding author

Correspondence to: Waleed Riad, Department of Anaesthesia, King Khaled Eye Specialist Hospital, P.O. Box 7191, Riyadh 11462, Kingdom of Saudi Arabia. E-mail: waleed_riad@yahoo.com; Tel: +966 1 482 1234 3215; Fax: +966 1 482 1908

References

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1.Rose, JB, Watcha, MF. Postoperative nausea and vomiting in paediatric patients. Br J Anaesth 1999; 83: 104117.
2.Elhakim, M, Ali, N, Rashed, I, Riad, M, Refat, M. Dexamethasone reduces postoperative vomiting and pain after pediatric tonsillectomy. Can J Anesth 2003; 50: 392397.
3.Splinter, WM, Rhine, EJ, Roberts, DJ. Vomiting after strabismus surgery in children: ondansetron vs. propofol. Can J Anaesth 1997; 44: 825829.
4.Gan, TJ. Evidence-based management of postoperative nausea and vomiting. Can J Anesth 2003; 50: R1R4.
5.Olynyk, JK, Cullen, SR, Leahy, MF. Midazolam: an effective antiemetic agent for cytotoxic chemotherapy (letter). Med J Aust 1989; 150: 466.
6.Splinter, WM, Noel, LP, Robert, D, Rhine, E, Bonn, G, Clarke, W. Antiemetic prophylaxis for strabismus surgery. Can J Opthalmol 1994; 29: 224226.
7.Macario, A, Weinger, M, Carney, S, Kim, A. Which clinical anesthesia outcomes are important to avoid? The perspective of patients. Anesth Analg 1999; 89: 652658.
8.Sekine, I, Nishiwaki, Y, Kakinuma, R et al. . Phase II study of high-dose dexamethasone-based association in acute and delayed high-dose cisplatin-induced emesis – JCOG study 9413. Br J Cancer 1997; 76: 9092.
9.Henzi, I, Walder, B, Tramèr, MR. Dexamethasone for the prevention of postoperative nausea and vomiting: a quantitative systemic review. Anesth Analg 2000; 90: 186194.
10.Parikh, PM, Charak, BS, Banavali, SD et al. . A prospective, randomized double-blind trial comparing metoclopramide alone with metoclopramide plus dexamethasone in preventing emesis induced by high-dose cisplatin. Cancer 1988; 62: 22632266.
11.Aldrete, JA, Kroulik, D. A post anesthetic recovery score. Anesth Analg 1970; 49: 924933.
12.Di Florio, T, Goucke, CR. The effect of midazolam on persistent postoperative nausea and vomiting. Anaesth Intens Care 1999; 27: 3840.
13.Khalil, SN, Berry, J, Howard, G et al. . The antiemetic effect of lorazepam after out-patient strabismus surgery in children. Anesthesiology 1992; 77: 915.
14.Sanjay, OP, Tauro, DI. Midazolam: an effective antiemetic after cardiac surgery – a clinical trial. Anesth Analg 2004; 99: 339343.
15.Palmer, GM, Cameron, DJ. Use of intravenous midazolam and clonidine in cyclical vomiting syndrome. Pediatr Anesth 2005; 15: 6872.
16.Unlugenc, H, Guler, T, Gunes, Y, Isik, G. Comparative study of the antiemetic efficacy of ondansetron, propofol and midazolam in the early postoperative period. Eur J Anaesthesiol 2004; 21: 6065.
17.Crowe, S. Midazolam: an anti-emetic? Anaesthesia 2002; 57: 830.
18.Philips, JW, Bender, AS, Wu, PH. Benzodiazepines inhibit adenosine uptake into rat brain synaptosomes. Brain Res 1980; 195: 494498.
19.Di Florio, T. Midazolam for PONV. What’s new? Anesthesia 2002; 57: 941.
20.Hanna, V, Päivi, A, Matti, V, Pekka, T. Premedication with midazolam delays recovery after ambulatory sevoflurane anesthesia in children. Anesth Analg 1999; 89: 7579.
21.Splinter, WM, MacNeill, H, Menard, E, Rhine, E, Roberts, DJ, Gould, MH. Midazolam reduces vomiting after tonsillectomy in children. Can J Anaesth 1995; 42: 201203.
22.Splinter, WM. Prevention of vomiting after strabismus surgery in children: dexamethasone alone versus dexamethasone plus low-dose ondansetron. Pediatr Anesth 2001; 11: 591595.
23.Subramaniam, B, Madan, R, Sadhasivam, S et al. . Dexamethasone is a cost-effective alternative to ondansetron in preventing PONV after paediatric strabismus repair. Br J Anaesth 2001; 86: 8489.
24.Pueyo, J, López-Olaondo, L, Sanchez-Ledesma, MJ, Ortega, A, Carrascosa, F. Combination of ondansetron and droperidol in the prophylaxis of postoperative nausea and vomiting. Br J Anaesth 2003; 91: 589592.
25.Fujii, Y, Saitoh, Y, Tanaka, H. Granisetron/dexamethasone combination for the prevention of postoperative nausea and vomiting after laparoscopic cholesystectomy. Eur J Anesthesiol 2000; 17: 6468.

Keywords

Effect of midazolam, dexamethasone and their combination on the prevention of nausea and vomiting following strabismus repair in children

  • W. Riad (a1), R. Altaf (a2), A. Abdulla (a2) and H. Oudan (a3)

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