OBJECTIVE: To investigate the advantages and disadvantages of sevoflurane-N2O inhalation anesthesia with laryngeal mask airway (LMA) and propofolketamine total intravenous anaesthesia in children undertaking strabismus surgery. METHODS: Eighty children undertaking strabismus surgery were randomly divided into sevoflurane-N2O inhalation anaesthesia group with LMA (volatile group, n=40) and propofol-ketamine total intravenous anesthesia group (TIVA group, n=40). LMA was used to secure respiratory airway in the volatile group, but LMA or endotracheal intubation was not used in the TIVA group. All children breathed spontaneously during operative period. The anesthesia was maintained with 2%-3% sevoflurane-50% N2O-50% O2 in the volatile group, and continuous intravenous infusion with propofol 5-10 mg/(kg x h) plus ketamine 1-2 mg/(kg x h) in the TIVA group. The incidence of SpO2 less than 95% and the movement of the limbs and head induced by operative stimulation, oculocardiac reflex (OCR) and postoperative vomiting (POV) were recorded in all children. RESULTS: The incidence of limbs and head movement, the incidence of SpO2 less than 95% and OCR were significantly lower in the volatile group than those in the TIVA group (P < 0.01); but the incidence of POV was significantly higher in the volatile group than that in the TIVA group (P < 0.01). CONCLUSION Sevoflurane-N2O-O2 anesthesia with LMA can secure respiratory airway of patients, avoid hypoxemia, and have good anesthetic quality and low OCR incidence. It is a new anesthesia method with more advantages in children undertaking strabismus surgery, but the prevention and treatment of POV must be noticed.
Anesthesia, Intravenous ; Anesthetics, Inhalation ; Child ; Child, Preschool ; China ; epidemiology ; Female ; Humans ; Ketamine ; Laryngeal Masks ; Male ; Methyl Ethers ; Nitrous Oxide ; Ophthalmologic Surgical Procedures ; Postoperative Nausea and Vomiting ; chemically induced ; epidemiology ; Propofol ; Sevoflurane ; Strabismus ; surgery

PURPOSE: We evaluated the incidence and risk factors of postoperative nausea and vomiting (PONV) in patients with fentanyl-based intravenous patient-controlled analgesia (IV-PCA) and single antiemetic prophylaxis of 5-hydroxytryptamine type 3 (5 HT3)-receptor antagonist after the general anesthesia. MATERIALS AND METHODS: In this retrospective study, incidence and risk factors for PONV were evaluated with fentanyl IV-PCA during postoperative 48 hours after various surgeries. RESULTS: Four hundred-forty patients (23%) of 1878 had showed PONV. PCA was discontinued temporarily in 268 patients (14%), mostly due to PONV (88% of 268 patients). In multivariate analysis, female, non-smoker, history of motion sickness or PONV, long duration of anesthesia (>180 min), use of desflurane and intraoperative remifentanil infusion were independent risk factors for PONV. If one, two, three, four, five, or six of these risk factors were present, the incidences of PONV were 18%, 19%, 22%, 31%, 42%, or 50%. Laparoscopic surgery and higher dose of fentanyl were not risk factors for PONV. CONCLUSION: Despite antiemetic prophylaxis with 5 HT3-receptor antagonist, 23% of patients with fentanyl-based IV-PCA after general anesthesia showed PONV. Long duration of anesthesia and use of desflurane were identified as risk factors, in addition to risk factors of Apfel's score (female, non-smoker, history of motion sickness or PONV). Also, intraoperative remifentanil infusion was risk factor independent of postoperative opioid use. As the incidence of PONV was up to 50% according to the number of risk factors, risk-adapted, multimodal or combination therapy should be applied.
Adult ; Aged ; Analgesia, Patient-Controlled/*adverse effects ; Analgesics, Opioid/*adverse effects/therapeutic use ; Antiemetics/administration & dosage/therapeutic use ; Female ; Fentanyl/*adverse effects/therapeutic use ; Humans ; Incidence ; Isoflurane/adverse effects/*analogs & derivatives/therapeutic use ; Male ; Middle Aged ; Piperidines/*adverse effects/therapeutic use ; Postoperative Nausea and Vomiting/chemically induced/*epidemiology ; Retrospective Studies ; Risk Factors

PURPOSE: Postoperative nausea and vomiting (PONV) is a common problem after general anesthesia. Although 5-hydroxytryptamine type 3 (5-HT3) receptor antagonists have significantly reduced PONV, over 35% of patients treated with ondansetron can experience PONV. In this study, we investigated whether the Y129S and -100_-102AAG deletion polymorphisms of the 5-HT3B receptor gene affect the efficacy of ondansetron in preventing PONV. MATERIALS AND METHODS: Two hundred and forty-five adult patients who underwent laparoscopic cholecystectomy were enrolled. Ondansetron 0.1 mg/kg was intravenously administered 30 minutes before the end of surgery. Genomic DNA was prepared from blood samples using a nucleic acid isolation device. Both the Y129S variant and the -100_-102AAG deletion variant were screened for using a single base primer extension assay and a DNA direct sequencing method, respectively. The relationship between genetic polymorphisms and clinical outcomes of ondansetron treatment was investigated. RESULTS: Among the 5-HT3B AAG deletion genotypes, the incidence of PONV was higher in patients with the homomutant than with other genotypes during the first 2 hours after surgery (p=0.02). There were no significant differences in the incidence of PONV among genotypes at 2-24 hours after surgery. In the Y129S variants of the 5-HT3B receptor gene, there were no significant differences in the incidence of PONV among genotypes during the first 2 hours and at 2-24 hours after surgery. CONCLUSION: The response to ondansetron for PONV was significantly influenced by the -100_-102AAG deletion polymorphisms of the 5-HT3B gene. Thus, the -100_-102AAG deletion variants may be a pharmacogenetic predictor for responsiveness to ondansetron for PONV.
Adult ; Aged ; Anesthesia, General ; Antiemetics/administration & dosage/*pharmacology ; Cholecystectomy, Laparoscopic ; Female ; Genome, Human ; Genotype ; Humans ; Incidence ; Injections, Intravenous ; Male ; Middle Aged ; Ondansetron/administration & dosage/*pharmacology ; Polymorphism, Genetic ; Postoperative Nausea and Vomiting/chemically induced/*drug therapy/epidemiology ; Receptors, Serotonin, 5-HT3/*drug effects/*genetics ; Time Factors