Metoclopramide Reduces the Incidence of Vomiting Following Strabismus Surgery in Children

Abstract

This randomized, double-blind study evaluated the efficacy of metoclopramide administered at the completion of surgery as an antiemetic agent in pediatric patients undergoing ambulatory strabismus surgery; 126 unpremedicated ASA Physical Status 1 and 2 children ranging in age from 2 to 18 yr served as subjects. All received general anesthesia with halothane, N2O, and O2; tracheal intubation was facilitated with intravenous (iv) atracurium 0.5 mg/kg. Intravenous atropine 0.02 mg/kg and lactated Ringer''s solution with 5% dextrose equivalent to 4 h maintenance fluids were administered during surgery. Neither opioids nor droperidol were given intraoperatively. At the completion of surgery, residual muscle paralysis was reversed with atropine 0.02 mg/kg (maximum dose 1.0 mg) and neostigmine 0.07 mg/kg (maximum dose 5.0 mg), and the stomach was decompressed prior to tracheal extubation. After the patient had been transferred to the postanesthesia recovery room (PARR) either metoclopramide 0.15 mg/kg or normal saline was administered intravenously to the children over a 1- min period. A research associate monitored the children for the incidence of postoperative vomiting and the time required for each child to meet discharge criteria from Short Stay Recovery Unit (SSRU). If a child vomited more than three times in both the PARR and SSRU, the vomiting was construed to be severe and the patient was offered further antiemetic treatment with iv droperidol 70 .mu.g/kg. The incidence of postoperative vomiting in the metoclopramide group was 37% versus 59% in the placebo group (P < 0.05). The time required for children who received metoclopramide to meet standard discharge criteria was 207.4 .+-. 60.0 min (range, 100-425 min), whereas that for controls was 248.8 .+-. 84.5 min (range, 110-480 min). This difference is also statistically significant (P < 0.002). Eight children who received the placebo required adjunct antiemetic therapy for protracted postoperative vomiting. None of the children who received metoclopramide had protracted or severe postoperative nausea and vomiting. This difference in the incidence of severe postoperative nausea and vomiting was statistically significant (P < 0.006). Finally, there were no adverse reactions to either metoclopramide or placebo, and none of the children appeared to be drowsy or sedated.