Study Compares Sevoflurane and Propofol for Squint Surgery in Children

Children who undergo strabismus surgery are at a high risk of experiencing postoperative vomiting. Recent study compared the incidence of postoperative vomiting (POV) in children undergoing strabismus surgery under balanced anesthesia with sevoflurane versus intravenous anesthesia with propofol. Seventy ASA I-II children aged 1-12 years were randomized to receive sevoflurane-based anesthesia (Group S) or propofol-based anesthesia (Group P) for maintenance. Surgical details, intraoperative hemodynamic parameters, recovery characteristics, and emergence delirium were recorded. The incidence of POV in the 0-2 hours, 2-6 hours, and 6-24 hours period was noted, and any rescue antiemetic administration was also recorded. The study found that the average duration of surgery was 118.2 ± 41.88 min in Group S and 137.32 ± 39.09 min in Group P, with no statistically significant difference in POV incidence in the first 24 hours between the two groups. The median time to discharge from the post anesthesia care unit (PACU) was significantly less in the propofol group (50 min) than in the sevoflurane group (60 min).

Study Conclusions

The study concludes that propofol-based anesthesia did not offer advantages over sevoflurane in reducing POV after squint surgery when dual prophylaxis with dexamethasone and ondansetron was administered. However, it did reduce the duration of stay in the PACU. The study also highlighted that all children fell into a high-risk category for POV, and the low POV incidence may be attributed to factors such as adequate hydration, avoidance of nitrous oxide, and satisfactory pain relief. The propofol group exhibited higher mean arterial pressure (MAP) than the sevoflurane group throughout the surgery, postinduction of anesthesia. No difference in the incidence of oculocardiac reflex (OCR) was identified between the propofol and sevoflurane groups in the study.

Overall Study Implications

Overall, the study indicates that propofol-based anesthesia may not offer a significant advantage over sevoflurane anesthesia in terms of reducing POV after squint surgery when dual prophylaxis with dexamethasone and ondansetron is administered. However, it may be beneficial in reducing the duration of stay in the PACU. The study also discusses the importance of using multimodal antiemetic agents and the role of procedural factors, anesthesia, and patient-related factors in influencing POV incidence in pediatric squint surgery.

Key Points

- The study concludes that propofol-based anesthesia did not offer advantages over sevoflurane in reducing POV after squint surgery when dual prophylaxis with dexamethasone and ondansetron was administered. However, it did reduce the duration of stay in the PACU. The study also highlighted that all children fell into a high-risk category for POV, and the low POV incidence may be attributed to factors such as adequate hydration, avoidance of nitrous oxide, and satisfactory pain relief. The propofol group exhibited higher mean arterial pressure (MAP) than the sevoflurane group throughout the surgery, postinduction of anesthesia. No difference in the incidence of oculocardiac reflex (OCR) was identified between the propofol and sevoflurane groups in the study.

- Overall, the study indicates that propofol-based anesthesia may not offer a significant advantage over sevoflurane anesthesia in terms of reducing POV after squint surgery when dual prophylaxis with dexamethasone and ondansetron is administered. However, it may be beneficial in reducing the duration of stay in the PACU. The study also discusses the importance of using multimodal antiemetic agents and the role of procedural factors, anesthesia, and patient-related factors in influencing POV incidence in pediatric squint surgery.

Reference –

Subramanian S, Shetty D, Shivanna P, Das P, Phadke M. Post‑operative vomiting after pediatric strabismus surgery: A comparison of propofol versus sevoflurane anaesthesia. J Anaesthesiol Clin Pharmacol 2024;40:305‑11