BACKGROUND: Children undergoing strabismus surgery have a high incidence of postoperative nausea and vomiting (PONV). Previous reports have proposed PONV risk factors with conflicting results. We reevaluated the risk factors following pediatric strabismus surgery.

METHODS: After obtaining informed consent, we conducted a prospective study of 58 ASA I children (aged 3-15 years) who had undergone elective strabismus surgery performed by the same ophthalmologist to investigate PONV risk factors. Anesthesia was induced with thiopental and rocuronium and maintained by inhalation anesthesia with 2 vol.% sevoflurane in 50% N2O/O2. Premedicants, anticholinergics, analgesics, or subtenon lidocaine injection were not used perioperatively. PONV was recorded by patients' parents during the first 24 hours after surgery. We analyzed the influence on PONV of age, sex, preoperative anxiety, oculocardiac reflex (OCR), and procedure duration.

RESULTS: The incidence of PONV was 25.9%. Age was found to be associated with PONV (P < 0.05). PONV occurred in 13.3% of preschoolers aged 7 years or less, but in 39.3% of school children aged 8 years or more (the odds ratio for age ≥ 8 year of age, 4.2, with 95% Cl 1.2-15.4). Sex, OCR, preoperative anxiety, and procedure duration did not affect PONV.

CONCLUSIONS: We found that only age is associated with PONV, and that the incidence of PONV is higher in school children than in preschoolers after pediatric strabismus surgery. These results suggest that much more attention should be paid to preventing PONV during strabismus surgery in school children.