Abstract
This randomized, double-blind study evaluated the antiemetic efficacy and the side-effects of promethazine pretreatment (0.5 mg · kg−1 IV + 0.5 mg · kg−1 IM) versus droperidol + placebo pretreatment (droperidol. 0.075 mg kg−1 IV + physiological saline, 0.02 ml · kg−1 IM). One hundred unpremeditated ASA physical status I children ranging from two to ten years, and undergoing outpatient strabismus surgery were studied. All children received inhalational anaesthesia with halothane, nitrous oxide and oxygen. Neither opioids nor muscle relaxants were used. The incidence of vomiting and/or retching and the incidence of side-effects were determined in the post-anaesthesia recovery room (PARR), in the short-stay surgical unit (SSSU), and after discharge from the hospital (including the journey and the stay at home during the first postoperative day). Promethazine and droperidol were equally effective in reducing the incidence of vomiting before discharge to two and eight per cent respectively. On the contrary, the incidences of vomiting after discharge and overall were significantly less with promethazine (ten and ten per cent) than with droperidol pretreatment (54 and 56 per cent) (P < 0.0001). Promethazine permitted the time to discharge from the hospital to be reduced to an average of three hours, without increasing the incidence of vomiting postdischarge. Promethazine pretreatment is much less expensive than droperidol pretreatment. The incidence of restlessness was significantly less with droperidol (eight per cent) than with promethazine (36 per cent) (P < 0.001). Promethazine pretreatment demands the use of an analgesic like acetaminophen in order to reduce the incidence of postoperative pain and restlessness. With the exception of restlessness, the overall incidence of side-effects was not statistically different between the two groups.
Résumé
Cette étude randomisée et à double insu a été réalisée dans le but d’évaluer et l’efficacité antiémétique et les effets indésirables du prétraitement à la prométhazine (0,5 mg · kg−1 IV + 0,5 mg · kg−1 IM) versus le prétraitement au droperidol + placebo (droperidol, 0,075 mg · kg−1 IV + sérum physiologique, 0.02 ml · kg−1 IM). Cent enfants non prémédiqués, à l’état physique I de la classification ASA, dont l’âge variait entre deux et dix ans et devant subir une correction de strabisme en courtséjour ont été étudiés. Tous ces enfants ont été anestliésiés à l’aide d’halothane, de protoxyde d’azote et d’oxygène. Aucun opiacé et aucun curarisant n’a été employé. L incidence de vomissements et l’incidence d’effets indésirables fûrent déterminées à la salle de réveil, à l’unité de courtséjour postopératoire, et après le congédiement de l’hôpital (transport vers la maison et séjour à domicile pendant la première journée postopératoire). Le prétraitement à la prométhazine a réduit l’incidence de vomissements pré-congédiement de l’hôpital (deux pour cent) autant que le prétraitement au droperidol (huit pour cent). Par contre, l’incidence de vomissements post-congédiement de l’hôpital et l’incidence globale de vomissements postopératoires fûrent significativement plus faibles chez le groupe d’enfants prétraités avec de la prométhazine (dix; dix pour cent) que chez le groupe prétraité avec du droperidol (54: 56 pour cent) (P < 0.0001). Le prétraitement à la prométhazine a permis de raccourcir la moyenne du temps de congédiement de l’hôpital aux alentours de trois heures sans augmenter l’incidence de vomissements post-congediement. Le prétraitement à la prométhazine coûte beaucoup moins cher que le prétraitement au droperidol. L’incidence d’agitation postopératoire fût significativement plus élevée avec la prométhazine (36 pour cent qu’avec le droperidol (huit pour cent) (P < 0,001). Les enfants prétraités à la prométhazine doivent recevoir un analgésique du type acétaminophène, dans le but de réduire l’incidence de douleurs et d’agitation postopératoires. Mise à part l’agitation, l’incidence globale d’effets indésirables n’a pas été statistiquement différente entre les deux types de prétraitement. Les auteurs discutent l’étiopathogénie des vomissements et la pharmacologie des antiémétiques chez les enfants exposés aux corrections de strabisme.
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Blanc, V.F., Ruest, P., Milot, J. et al. Antiemetic prophylaxis with promethazine or droperidol in paediatric outpatient strabismus surgery. Can J Anaesth 38, 54–60 (1991). https://doi.org/10.1007/BF03009164
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DOI: https://doi.org/10.1007/BF03009164