{"title":"斜视手术儿童麻醉方案改变对术后呕吐的影响：中断时间序列分析。","authors":"Taiki Kojima, Yusuke Yamauchi, Sayuri Yasuda, Soichiro Obara, Takashi Fujiwara, Aya Sueda","doi":"10.1111/pan.70041","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Preventive measures for postoperative vomiting (POV) in pediatric strabismus surgery are essential. Previous experimental studies have shown the independent antiemetic effects of propofol-based total intravenous anesthesia (TIVA), dexamethasone (DEX), and ondansetron (OND). However, the real-world outcomes of POV following the combined use of DEX and OND with propofol/opioid TIVA remain unknown.</p><p><strong>Aims: </strong>To evaluate the longitudinal incidence of POV across three phases of different anesthesia regimens.</p><p><strong>Methods: </strong>This retrospective observational study was conducted at a single tertiary-care children's hospital in Japan, including children aged < 18 years who underwent strabismus surgery and had no major comorbidities. The primary outcome was either POV or the use of antiemetics within 24 h or by discharge. Changes in the levels and time-trend slopes of POV were evaluated using interrupted time series analysis among three phases: (1) sevoflurane with pentazocine, (2) propofol/opioid TIVA with DEX, and (3) propofol/opioid TIVA with DEX and OND.</p><p><strong>Results: </strong>Of the 2378 children, the POV incidence in Phases 1, 2, and 3 was 109/471 (23.1%), 87/1260 (6.9%), and 28/647 (4.3%), respectively (p < 0.001). A significant level change in POV occurrence was observed from Phase 1 to Phase 2, while no significant level change was found from Phase 2 to Phase 3. The time-trend changes in POV occurrence showed no significant difference during Phases 2 and 3.</p><p><strong>Conclusions: </strong>Real-world departmental-level data showed a decrease in POV occurrence after transitioning from sevoflurane-based anesthesia with pentazocine to propofol/opioid TIVA with DEX. However, no significant decrease in POV occurrence was found by adding OND to propofol/opioid TIVA with DEX. Further studies are needed to improve the generalizability of evaluating the real-world antiemetic effect of combining antiemetic medications on propofol/opioid TIVA.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.7000,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Real-World Impact on Postoperative Vomiting by Changing Anesthesia Regimens in Children Undergoing Strabismus Surgery: An Interrupted Time Series Analysis.\",\"authors\":\"Taiki Kojima, Yusuke Yamauchi, Sayuri Yasuda, Soichiro Obara, Takashi Fujiwara, Aya Sueda\",\"doi\":\"10.1111/pan.70041\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Preventive measures for postoperative vomiting (POV) in pediatric strabismus surgery are essential. Previous experimental studies have shown the independent antiemetic effects of propofol-based total intravenous anesthesia (TIVA), dexamethasone (DEX), and ondansetron (OND). However, the real-world outcomes of POV following the combined use of DEX and OND with propofol/opioid TIVA remain unknown.</p><p><strong>Aims: </strong>To evaluate the longitudinal incidence of POV across three phases of different anesthesia regimens.</p><p><strong>Methods: </strong>This retrospective observational study was conducted at a single tertiary-care children's hospital in Japan, including children aged < 18 years who underwent strabismus surgery and had no major comorbidities. The primary outcome was either POV or the use of antiemetics within 24 h or by discharge. Changes in the levels and time-trend slopes of POV were evaluated using interrupted time series analysis among three phases: (1) sevoflurane with pentazocine, (2) propofol/opioid TIVA with DEX, and (3) propofol/opioid TIVA with DEX and OND.</p><p><strong>Results: </strong>Of the 2378 children, the POV incidence in Phases 1, 2, and 3 was 109/471 (23.1%), 87/1260 (6.9%), and 28/647 (4.3%), respectively (p < 0.001). A significant level change in POV occurrence was observed from Phase 1 to Phase 2, while no significant level change was found from Phase 2 to Phase 3. The time-trend changes in POV occurrence showed no significant difference during Phases 2 and 3.</p><p><strong>Conclusions: </strong>Real-world departmental-level data showed a decrease in POV occurrence after transitioning from sevoflurane-based anesthesia with pentazocine to propofol/opioid TIVA with DEX. However, no significant decrease in POV occurrence was found by adding OND to propofol/opioid TIVA with DEX. Further studies are needed to improve the generalizability of evaluating the real-world antiemetic effect of combining antiemetic medications on propofol/opioid TIVA.</p>\",\"PeriodicalId\":19745,\"journal\":{\"name\":\"Pediatric Anesthesia\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":1.7000,\"publicationDate\":\"2025-08-22\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Pediatric Anesthesia\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1111/pan.70041\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"ANESTHESIOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Pediatric Anesthesia","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1111/pan.70041","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
Real-World Impact on Postoperative Vomiting by Changing Anesthesia Regimens in Children Undergoing Strabismus Surgery: An Interrupted Time Series Analysis.
Background: Preventive measures for postoperative vomiting (POV) in pediatric strabismus surgery are essential. Previous experimental studies have shown the independent antiemetic effects of propofol-based total intravenous anesthesia (TIVA), dexamethasone (DEX), and ondansetron (OND). However, the real-world outcomes of POV following the combined use of DEX and OND with propofol/opioid TIVA remain unknown.
Aims: To evaluate the longitudinal incidence of POV across three phases of different anesthesia regimens.
Methods: This retrospective observational study was conducted at a single tertiary-care children's hospital in Japan, including children aged < 18 years who underwent strabismus surgery and had no major comorbidities. The primary outcome was either POV or the use of antiemetics within 24 h or by discharge. Changes in the levels and time-trend slopes of POV were evaluated using interrupted time series analysis among three phases: (1) sevoflurane with pentazocine, (2) propofol/opioid TIVA with DEX, and (3) propofol/opioid TIVA with DEX and OND.
Results: Of the 2378 children, the POV incidence in Phases 1, 2, and 3 was 109/471 (23.1%), 87/1260 (6.9%), and 28/647 (4.3%), respectively (p < 0.001). A significant level change in POV occurrence was observed from Phase 1 to Phase 2, while no significant level change was found from Phase 2 to Phase 3. The time-trend changes in POV occurrence showed no significant difference during Phases 2 and 3.
Conclusions: Real-world departmental-level data showed a decrease in POV occurrence after transitioning from sevoflurane-based anesthesia with pentazocine to propofol/opioid TIVA with DEX. However, no significant decrease in POV occurrence was found by adding OND to propofol/opioid TIVA with DEX. Further studies are needed to improve the generalizability of evaluating the real-world antiemetic effect of combining antiemetic medications on propofol/opioid TIVA.
期刊介绍：
Devoted to the dissemination of research of interest and importance to practising anesthetists everywhere, the scientific and clinical content of Pediatric Anesthesia covers a wide selection of medical disciplines in all areas relevant to paediatric anaesthesia, pain management and peri-operative medicine. The International Editorial Board is supported by the Editorial Advisory Board and a team of Senior Advisors, to ensure that the journal is publishing the best work from the front line of research in the field. The journal publishes high-quality, relevant scientific and clinical research papers, reviews, commentaries, pro-con debates, historical vignettes, correspondence, case presentations and book reviews.
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