Anticholinergic prophylaxis does not prevent emesis following strabismus surgery in children

Chisakuta, A M; Mirakhur, R. K.

doi:10.1111/j.1460-9592.1995.tb00252.x

Cited by 117 publications

(29 citation statements)

References 18 publications

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“…Antihistamines, although widely used for migraine, are generally recommended for motion sickness as they act at the level of the vestibular apparatus 43,52. Anti-cholinergic agents such as atropine and hyoscine are relatively ineffective in the treatment or prevention of vomiting due to causes other than motion sickness 52–54. The mechanism of action is not clearly understood in some antiemetic medications such as dexamethasone and trimethobenzamide.…”

Section: The Pathophysiology Of Vomiting and The Mechanisms Of Antiemmentioning

confidence: 99%

Acute gastroenteritis: from guidelines to real life

Chow

Leung²,

Hon³

2010

CEG

111

100

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Acute gastroenteritis is a very common disease. It causes significant mortality in developing countries and significant economic burden to developed countries. Viruses are responsible for approximately 70% of episodes of acute gastroenteritis in children and rotavirus is one of the best studied of these viruses. Oral rehydration therapy is as effective as intravenous therapy in treating mild to moderate dehydration in acute gastroenteritis and is strongly recommended as the first line therapy. However, the oral rehydration solution is described as an underused simple solution. Vomiting is one of the main reasons to explain the underuse of oral rehydration therapy. Antiemetics are not routinely recommended in treating acute gastroenteritis, though they are still commonly prescribed. Ondansetron is one of the best studied antiemetics and its role in enhancing the compliance of oral rehydration therapy and decreasing the rate of hospitalization has been proved recently. The guidelines regarding the recommendation on antiemetics have been changed according to the evidence of these recent studies.

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Section: The Pathophysiology Of Vomiting and The Mechanisms Of Antiemmentioning

confidence: 99%

Acute gastroenteritis: from guidelines to real life

Chow

Leung²,

Hon³

2010

CEG

111

100

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“…2 Administering atropine or glycopyrrolate decreases the incidence of OCR; 2,5,23,25 however, systematic prophylactic anticholinergic administration remained controversial in the past because it was associated with ventricular arrhythmias. Also, in most of these reports, the patients were receiving halothane anesthesia, which also increased the incidence of arrhythmias.…”

Section: Prevention Of Ocrmentioning

confidence: 99%

“…It has also been suggested that prophylactic anticholinergics be used to reduce the rate of PONV by decreasing the incidence of OCR; however, this option has not been demonstrated in pediatric strabismus. 25 …”

Section: Prevention Of Ocrmentioning

confidence: 99%

“…2 L'administration d'atropine ou de glycopyrrolate réduit l'incidence de ROC; 2,5,23,25 toutefois, l'administration systématique d'agents anticholinergiques en prophylaxie était controversée par le passé en raison d'une association avec des arythmies ventriculaires. De plus, dans la plupart de ces comptes-rendus, les patients ont reçu une anesthésie à l'halothane, ce qui a également augmenté l'incidence d'arythmies.…”

Section: Prévention Du Rocunclassified

“…Il a également été suggéré d'utiliser les traitements anticholinergiques en prophylaxie pour réduire les taux de NVPO en réduisant l'incidence de ROC; toutefois, cette alternative n'a pas été testée chez une cohorte d'enfants atteints de strabisme. 25 …”

Section: Prévention Du Rocunclassified

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Anesthetic management for pediatric strabismus surgery: Continuing Professional Development

Rodgers

Cox

2010

Can J Anesth/J Can Anesth

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Purpose Strabismus surgery is one of the most common pediatric ophthalmic procedures. The purpose of this continuing professional development module is to update physicians on the anesthetic considerations of pediatric patients undergoing strabismus surgery. Principal findings The preoperative assessment is important, as patients undergoing strabismus surgery may have an associated neuromuscular disorder, congenital syndrome, or cardiac disease. Malignant hyperthermia is no longer considered as being an issue associated with strabismus. The laryngeal mask airway is used frequently and has been shown as being associated with a low incidence of complications in strabismus surgery. The anesthesia technique can be adapted to decrease the incidence of the oculocardiac reflex and the oculorespiratory reflex, and the use of anticholinergic prophylaxis remains debatable. Since patients are at high risk for postoperative nausea and vomiting (PONV), combination anti-emetic therapy is recommended using dexamethasone and ondansetron. Metoclopramide was not found to provide additional benefit when combined with other anti-emetics. Droperidol is effective, but there remains a black box warning for dysrhythmias. Effective analgesics in this patient population include acetaminophen, nonsteroidal anti-inflammatory drugs, peribulbar blocks, and subtenon blocks. Topical tetracaine drops have demonstrated mixed results, and topical nonsteroidal anti-inflammatory drops were found not to be effective. The use of opioids should be minimized due to the increased incidence of PONV. Conclusions To provide optimal care for the pediatric patient undergoing strabismus surgery, it is important to understand the unique anesthetic considerations for strabismus surgery and to appreciate how each decision regarding the anesthetic technique can alter these considerations. Objectives of this continuing professional development (CPD) moduleUpon completion of this CPD module, the reader will be able to:1 Perform a thorough preoperative assessment with an emphasis on the co-existing diseases and syndromes with ocular manifestations; 2. Evaluate the possibility of an increased incidence of masseter muscle spasm or malignant hyperthermia in this patient group; 3. Detail an anesthetic plan for strabismus surgery, including airway management and choice of anesthetic agents; 4. Understand the mechanism of the oculocardiac and the oculorespiratory reflex and recognize the associated risk factors and treatment; 5. Determine the analgesia options for strabismus surgery; and 6. Plan evidence-based anti-emetic prophylaxis for strabismus surgery. Summary reviewStrabismus surgery is the most common pediatric ophthalmic procedure. 1,2 The purpose of this continuing professional development module is to review the unique anesthetic issues facing a patient presenting for strabismus surgery. It is important to be aware of specific issues, such as the association with specific syndromes and diseases, the occurrence of the oculocardiac reflex, and the increas...

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Drugs for preventing postoperative nausea and vomiting

Carlisle

Stevenson²

2006

Cochrane Database of Systematic Reviews

227

133

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Either nausea or vomiting is reported to affect, at most, 80 out of 100 people after surgery. If all 100 of these people are given one of the listed drugs, about 28 would benefit and 72 would not. Nausea and vomiting are usually less common and, therefore, drugs are less useful. For 100 people, of whom 30 would vomit or feel sick after surgery if given placebo, 10 people would benefit from a drug and 90 would not. Between one to five patients out of every 100 people may experience a mild side effect, such as sedation or headache, when given an antiemetic drug. Collaborative research should focus on determining whether antiemetic drugs cause more severe, probably rare, side effects. Further comparison of the antiemetic effect of one drug versus another is not a research priority.

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Anticholinergic prophylaxis does not prevent emesis following strabismus surgery in children

Cited by 117 publications

References 18 publications

Acute gastroenteritis: from guidelines to real life

Acute gastroenteritis: from guidelines to real life

Anesthetic management for pediatric strabismus surgery: Continuing Professional Development

Drugs for preventing postoperative nausea and vomiting

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