Penehyclidine mitigates postoperative nausea and vomiting and intraoperative oculocardiac reflex in patients undergoing strabismus surgery: a prospective, randomized, double-blind comparison

Jiacheng Sun, Xiaofei Cao, Ting Lu, Nan Li, Xinxu Min, Zhengnian Ding, Jiacheng Sun, Xiaofei Cao, Ting Lu, Nan Li, Xinxu Min, Zhengnian Ding

Abstract

Background: Postoperative nausea and vomiting (PONV) is one of the most frequent complications following strabismus surgery. Penehyclidine, an anticholinergic agent, is widely used as premedication. This study investigated the effect of preoperative penehyclidine on PONV in patients undergoing strabismus surgery.

Methods: In this prospective, randomized, double-blind study, patients scheduled for strabismus surgery under general anesthesia were randomly assigned to either penehyclidine (n = 114) or normal saline (n = 104) group. Penehyclidine was administrated immediately after anesthesia induction, and normal saline was substituted as control. PONV was investigated from 0 to 48 h after surgery. Intraoperative oculocardiac reflex (OCR) was also recorded.

Results: Compared with normal saline, penehyclidine significantly reduced PONV incidence (30.7% vs. 54.8%, P < 0.01) and mitigated PONV severity as indicated by severity scoring (P < 0.01). Compared with normal saline, penehyclidine also significantly reduced OCR incidence (57.9% vs. 77.9%, P < 0.01) and mitigated OCR severity, as indicated by the requirement for atropine rescue (77.3% vs. 90.1%, P < 0.05) and the maximum decrease of heart rate during OCR (23.1 ± 9.4 bpm vs. 27.3 ± 12.4 bpm, P < 0.05). The recovery course did not differ between groups.

Conclusions: Penehyclidine administrated after anesthesia induction significantly reduced the incidence of PONV and alleviated intraoperative OCR in patients undergoing strabismus surgery.

Trial registration: ClinicalTrials.gov ( NCT04054479 ). Retrospectively registered August 13, 2019.

Keywords: Anesthesia; Oculocardiac reflex (OCR); Penehyclidine; Postoperative nausea and vomiting (PONV); Strabismus surgery.

Conflict of interest statement

The authors declared that they have no competing interests.

Figures

Fig. 1
Fig. 1
Consort flow diagram. Total 228 patients were randomly allocated to penehyclidine or normal saline group. Among them, 10 patients dropped out due to lost contact or using inhalation anesthesia induction in pediatric patients who did not cooperate with intravenous induction. Finally, 218 patients were analyzed (n = 104 in normal saline group and n = 114 in penehyclidine group)
Fig. 2
Fig. 2
Penehyclidine reduced the incidence and mitigated the severity of PONV in patients undergoing strabismus surgery. a The overall incidence of PONV were recorded within 48 h after tracheal extubation. b The severity of PONV was scored using a numeric rank scoring system ranging from 0 to 3, wherein 0 represented no nausea and no vomiting and 3 represented vomiting on more than two occasions. **P < 0.01 analyzed by Fisher’s exact test (a) or by Mann-Whitney U test (b). The numbers of patients are shown in the figures. PONV, postoperative nausea and vomiting
Fig. 3
Fig. 3
The anti-PONV effect of penehyclidine over time. The PONV incidences in different postoperative periods are shown in the figure. †P < 0.01 vs. the incidence during 2 ~ 6 h in normal saline group; **P < 0.01 and *P < 0.05 vs. the time-matched normal saline group, analyzed by Fisher’s exact test. PONV, postoperative nausea and vomiting
Fig. 4
Fig. 4
Penehyclidine reduced the incidence and severity of OCR during strabismus surgery. a The incidence of OCR in each group. b The requirement for atropine rescue in patients with OCR. c The maximum decrease of heart rate during OCR. **P < 0.01 and *P < 0.05 analyzed by Fisher’s exact test (a, b) or by unpaired student t-test (c). The numbers of patients are shown in the figures. The maximum decreases of heart rate are shown as means ± standard deviation. OCR, oculocardiac reflex; bpm, beats per minute

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Source: PubMed

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