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PEDIATRIC ANESTHESIA

Reduction of Postoperative Nausea and Vomiting by Dimenhydrinate Suppositories after Strabismus Surgery in Children

Ingeborg D. Welters, MD^*, Thilo Menges, MD^*, Michael Gräf, MD, Christina Beikirch^*, Axel Menzebach^*, and Gunter Hempelmann, MD, PhD^*

Departments of *Anesthesiology and Strabismology and Neuroophthalmology, University of Giessen, Giessen, Germany

Address correspondence and reprint requests to Ingeborg D. Welters, MD, Department of Anaesthesiology and Intensive Care, Justus-Liebig-University Giessen, Rudolf-Buchheim-Str. 7, D-35385 Giessen, Germany.

Although dimenhydrinate has been used for treatment and prevention of postoperative nausea and vomiting (PONV) since the fifties, there have been few controlled studies about its efficacy. We performed a double-blinded study of 301 children aged 4 to 10 yr who underwent strabismus surgery. Preanesthetic medication with midazolam (0.5 mg/kg) as well as application of either dimenhydrinate suppositories or a placebo preparation was performed 30 min before the induction of anesthesia. Anesthesia was induced with thiopentone (5–10 mg/kg) and vecuronium (0.1 mg/kg) and maintained with halothane (1%–2%) in N₂O/O₂ (65%/35%). The incidence of PONV, requirements for rescue dimenhydrinate, and time to recovery were recorded. The overall incidence of PONV was 60.1% in the placebo group and 30.7% in the dimenhydrinate group. In the dimenhydrinate group, children had to be observed in the recovery room significantly longer than those in the placebo group. Children having received dimenhydrinate were discharged from the recovery room with lower arousal scores. We conclude that the rectal administration of dimenhydrinate is effective for the prevention of PONV, although the sedative effect may require longer postoperative monitoring.

Implications: We performed a double-blinded, randomized study to investigate the effects of prophylactic rectal dimenhydrinate application on postoperative nausea and vomiting in children undergoing strabismus surgery. In comparison with placebo, dimenhydrinate reduced the incidence of postoperative vomiting from 60.1% to 30.7%.

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