Antiemetic effect of subhypnotic doses of propofol after thyroidectomy

Abstract

Postoperative nausea and vomiting (PONV) are unpleasant, often underestimated side effects of anaesthesia and surgery, not devoid of medical complications. Prevention with antiemetics is only partially effective. Propofol has been shown recently to possess antiemetic properties in several situations. In this prospective, randomized, controlled trial, we have compared the antiemetic efficacy of subhypnotic doses of propofol, with Intralipid as placebo, after thyroidectomy. We studied 64 patients of both sexes, aged 22-71 yr, ASA I or II, undergoing thyroidectomy. After premedication with a benzodiazepine, balanced anaesthesia was produced with isoflurane and nitrous oxide in oxygen, and supplementary analgesia with fentanyl i.v. as required. Postoperative analgesia was provided with non-opioids, and piritramide 0.25 mg kg-1 i.m. on demand. Patients were allocated randomly and blindly to receive a 20-h infusion of either propofol or 10% Intralipid 0.1 ml kg-1 h-1. Intralipid, the excipient of propofol, was chosen as placebo as it is devoid of antiemetic effects. Sedation scores, respiratory and cardiovascular variables, and incidence of PONV were assessed every 4 h for 24 h. Pulse oximetry and ECG were monitored continuously. Both groups were comparable in characteristics, surgical and anaesthesia procedures, amount of opioids given during and after operation, and total amount of the study drug infused after operation. Occurrence of PONV was similar before the start (propofol 41%, Intralipid 50%) and after completion (propofol 0.64%, Intralipid 1.6%) of infusion and decreased with time in both groups during the infusion. However, symptoms were reduced to nil with propofol but persisted and were more severe with Intralipid during infusion (P < or = 0.01). The overall incidence of PONV during infusion was 10% (three of 32 patients) in the propofol group and 65% (21 of 32 patients) in the Intralipid group. Cardiovascular and respiratory variables, and SpO2 were unaltered, and sedation decreased similarly with time in both groups. We conclude that propofol, given at subhypnotic doses, effectively reduced the incidence of PONV without untoward sedative or cardiovascular effects.

Nausea and vomiting after ENT surgeries: A comparison between ondansetron, metoclopramide and small dose of propofol

“…The overall incidence of PONV in propofol group was has reported failure of propofol in treating postoperative vomiting in children undergoing tonsillectomy. Contrary to our results, small dose of propofol was effective in thyroidectomy in trials of Ewalenko et al (1996) [3] and Fujii et al (2001) [4]. However former used continuous infusion of propofol in low dose.…”

“…Propofol an anesthetic agent possesses antiemetic action. Recent studies have reported excellent antiemetic effect of sub hypnotic dose of propofol following thyroid surgery (Ewalenko et al 1996, Fujii et al 2001 [3,4] but it has not been used for other ENT surgeries. We therefore conducted a study to investigate the possible antiemetic effect of small dose of propofol following ENT surgeries and compared it with ondansetron and metoclopramide, the most commonly used antiemetics in our ENT ward.…”

Target‐controlled propofol vs. sevoflurane: a double‐blind, randomised comparison in day‐case anaesthesia

“…Finally, we only considered PONV up to the point of hospital discharge and it is possible that propofol simply delayed, rather than prevented, PONV. Although propofol is generally recognised to possess anti-emetic effects [24], these effects are relatively short lived [25].…”

Comparison of prophylactic anti-emetic effects of ramosetron between single bolus administration and continuous infusion following bolus administration

“…A high incidence of PONV has been reported in female patients undergoing thyroidectomy without antiemetic treatment. Although the reason for the high incidence of PONV after thyroidectomy is not clear, several factors are probably related to including middle-age, the female gender of patients, and vagal stimulation by the surgical handling of the neck [2,12]. In the current study, we reported that 81% of patients in the control group (Group 1) had PONV during the postoperative 24 h. This incidence was higher than that of previous studies of PONV in patients without prophylactic antiemetic treatment who underwent thyroidectomy with inhalation anesthesia (60-65%) [2,[11][12][13].…”