British Journal of Anaesthesia, Vol 75, Issue 5 556-561, Copyright © 1995 by The Board of Management and Trustees of the British Journal of Anaesthesia
M. Tramer, A. Moore and H. McQuay
Randomized controlled studies were reviewed to assess the effectiveness and
safety of antiemetics used for prophylaxis in paediatric strabismus
surgery. Early and late vomiting (6 and 48 h after operation,
respectively), and adverse effects were evaluated using the numbers-
needed-to-treat method. In 27 reports with information on 2033 children,
the mean incidence of early vomiting was 54% and of late vomiting 59%,
without prophylaxis. Only three drugs were studied sufficiently for firm
conclusions to be drawn. In the best documented regimen (droperidol 75
micrograms kg-1), four children have to be given the drug to prevent one
vomiting; of the three others, one may vomit and two would not have vomited
anyway; fewer than one child in 100 may have an extrapyramidal reaction and
16 may have minor adverse effects. Metoclopramide 0.15 and 0.25 mg kg-1 was
significantly better than control only for early vomiting. Propofol had a
high incidence of oculocardiac reflex without conferring any significant
antiemetic effect: it should not be used. The benefits of prophylactic
antiemetic therapy are not proven.
CLINICAL INVESTIGATIONS
Prevention of vomiting after paediatric strabismus surgery: a systematic review using the numbers-needed-to-treat method
Oxford Pain Relief Unit, Churchill Hospital, Headington, Oxford, Oxford OX3 7LJ
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