{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T02:12:02Z","timestamp":1778724722006,"version":"3.51.4"},"reference-count":33,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2017,11,2]],"date-time":"2017-11-02T00:00:00Z","timestamp":1509580800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Departments of Anaesthesiology, University Hospital D\u00fcsseldorf and University Hospital W\u00fcrzburg, Germany"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2017,12]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Postoperative nausea and postoperative vomiting are frequent but often missed complications after general anesthesia in pediatric patients. Because inhaled anesthetics are known to trigger postoperative vomiting, total intravenous anesthesia is often administered in high\u2010risk children to avoid the use of inhalational anesthesia. Since inhalational anesthesia might be advantageous in some situations, the question is raised whether administration of pharmacological prophylaxis offers equal protection from postoperative vomiting compared with total intravenous anesthesia alone.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>The aim of this systematic review was to compare total intravenous anesthesia with single\u2010drug pharmacological prophylaxis for the protection of postoperative vomiting in pediatric patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a systematic review (<jats:italic><jats:styled-content style=\"fixed-case\">EMBASE<\/jats:styled-content><\/jats:italic>,<jats:italic> <jats:styled-content style=\"fixed-case\">MEDLINE<\/jats:styled-content><\/jats:italic>, and <jats:italic><jats:styled-content style=\"fixed-case\">CENTRAL<\/jats:styled-content><\/jats:italic>) with meta\u2010analysis on randomized controlled trials including patients &lt;18 years of age undergoing general anesthesia, with one group receiving propofol\u2010based total intravenous anesthesia and another group receiving inhalational anesthesia with single pharmacological prophylaxis. Primary outcome was the overall incidence for postoperative vomiting. Secondary outcomes included early and late postoperative vomiting, the need for postoperative antiemetic medication, time to first oral intake, duration of stay in the postanesthesia care unit, and any adverse events defined as such by the respective authors. Risk ratios (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content>) or mean differences (<jats:styled-content style=\"fixed-case\">MD<\/jats:styled-content>) with 95% confidence intervals (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>) were calculated using a random effects model with inverse variance weighting.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Four randomized controlled trials including 558 children were included in the final analysis. All patients underwent strabismus surgery. Total intravenous anesthesia and single pharmacological prophylaxis were equally effective in preventing overall postoperative vomiting (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content> 0.99 [95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.77; 1.27]; 4 trials), as well as vomiting in the early (1.48 [0.78; 2.83]; 4 trials) and late (0.89 [0.56;1.42]; 2 trials) postoperative period. There was no difference in the need for postoperative antiemetic medication. Although patients resumed drinking and eating significantly earlier following total intravenous anesthesia (<jats:styled-content style=\"fixed-case\">MD<\/jats:styled-content> \u22121.40 hours [\u22122.01; \u22120.80], <jats:italic>P<\/jats:italic> &lt; .001), the duration of <jats:styled-content style=\"fixed-case\">PACU<\/jats:styled-content> stay did not differ between groups. The incidence of intraoperative oculocardiac reflex was the only reported adverse event, which was more likely to occur after total intravenous anesthesia (1.86 [1.01; 3.41]).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Single pharmacological prophylaxis appears equally effective compared with total intravenous anesthesia in preventing postoperative vomiting in pediatric patients. However, during strabismus surgery, total intravenous anesthesia increases the risk for bradycardia due to oculocardiac reflex. Thus, when anesthesia is maintained with inhalational anesthetics, its emetogenic effects can sufficiently be compensated by the addition of a single prophylactic antiemetic medication.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pan.13268","type":"journal-article","created":{"date-parts":[[2017,11,2]],"date-time":"2017-11-02T08:50:41Z","timestamp":1509612641000},"page":"1202-1209","source":"Crossref","is-referenced-by-count":34,"title":["Total intravenous anesthesia vs single pharmacological prophylaxis to prevent postoperative vomiting in children: A systematic review and meta\u2010analysis"],"prefix":"10.1111","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8186-4748","authenticated-orcid":false,"given":"Maximilian S.","family":"Schaefer","sequence":"first","affiliation":[{"name":"Department of Anesthesiology University Hospital D\u00fcsseldorf D\u00fcsseldorf 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