소아의 사시교정술 시 안구심반사와 술후 오심 구토에 대한 propofol-nitrous oxide와 propofol-전정맥마취의 비교

Abstract

Background : Intraoperative ocutocardiac reflex (OCR) and postoperative nausea and vomiting (PONV) are common problems of pediatrie strabismus surgery. Propofol is thought to increase the incidence of OCR in spite of profound antlemetic effect. The goal of this study was to assess, in pediatric strabismus surgery, the incidence of OCR and PONV in a prapofol with and without nitrous oxide (NO) anesthesia. Methods: Children (1-14yr.'s) undergoing strabismus surgery as in patients were randomly allacated to two anesthetic techniques: propofol with 60% N2O and propofol with air instead of N2O. All children received iv fentanyl 2 mg/kg, atropine 0.015 mg/kg and 1% lidocaine l.5- 2 ml before propofol 2.5 mg/kg injection. Anesthesia was maintained with three stage infusion method of pmpofol with and without N2O by groups after intubation with atracurium 0.4 mg/kg. A signiticant OCR was defined as an acute decrease in heart rate of 20% or greater associated with traction on an ocutar muscle. Results : Data on 224 children were analyzed. An intraoperative OCR was eliqited in 41 (36.9%) of the 111 children in the N2O group and in 66 (58.4%) of rhe 113 children in Air group, while 14 (12.6%) and 12 (10.6%) developed PONV in the N2O group and the Air group in the subsequent 24 h period. The OCR was more frequent during medial rectus muscle correction (62.5%) than in lateral rectus muscle correction (39.5%). There was no significant correlation betwecn OCR and PONV. Conclusions: We conclude that propofol with N2O anesthesia was effective in reducing the incidence of intraoperative OCR with a similarly excellent postoperetive antiemetic effect in pediatric strabismus surgery compared to propofol without N2O anesthesia.