Effect of sub-hypnotic dose of propofol on prevention of postoperative nausea and vomiting as part of multimodal antiemetic in patients undergoing open abdominal surgery: A prospective cohort study, Gondar University Hospital, Northwest Ethiopia, 2016

Abstract

Background: Postoperative nausea and vomiting (PONV) is one of the most common and unpleasant symptoms affecting patients undergoing abdominal surgery under general anaesthesia. It is also associated with complications such as gastric aspiration, bleeding, dehydration, wound dehiscence and delayed hospital discharge. Objective: The aim of this study was to assess the effect of a sub hypnotic dose of propofol on the occurrence and severity of PONV after open abdominal surgery under general anaesthesia. Materials and methods: A series of 72 adult (age ≥18) ASA class I or II patients, scheduled for open abdominal surgery were divided into a control group (n = 36) and a propofol group (n = 36). The propofol group was given 30 mg of 1% propofol IV bolus after skin closure. All episodes and severity of PONV during the first 24 h after anaesthesia were evaluated. Results: The overall incidence of PONV was significantly lower in propofol group than the non-propofol group during the first six postoperative hours (30.6% versus 66.7% respectively; p = 0.002). There was a significant reduction in number of patients needing rescue anti-emetic during the first six postoperative hours in propofol group when compared with none-propofol group [5 (13.9%) and 15 (41.7%) respectively, (p = 0.009)]. There were no significant differences between the groups with regard to their haemodynamic parameters and manifestations of respiratory depression. Conclusion and recommendation: Administration of a sub hypnotic intravenous dose of propofol was effective in reducing the incidence and severity of PONV, and the need for rescue anti-emetic during the first six postoperative hours in patients undergoing open abdominal surgery under general anaesthesia. We recommend the use of 30 mg propofol at the end of open abdominal surgery as part of multimodal approach for PONV. Highlights:

Effectiveness of Propofol versus Dexamethasone for Prevention of Postoperative Nausea and Vomiting in Ear, Nose, and Throat Surgery in Tikur Anbessa Specialized Hospital and Yekatit 12th Hospital, Addis Ababa, Ethiopia

“…Statistically significant results were obtained at the 12th to 24th hour time period ( p < 0.044). Studies suggest that effective concentration of propofol is better maintained in IV infusion rather than bolus dosing to prevent PONV [ 27 , 28 ]. The antiemetic effect of propofol is attributed to modulation of subcortical pathways to inhibit nausea or its direct depressant action on the vomiting center [ 29 ].…”

Propofol with Varied Functions: A Potential Therapeutic Opportunity for Postoperative Nausea, Vomiting and Pruritus—A Narrative Review

“…In patients anesthetized with Propofol as opposed to Sevoflurane, the incidence of PONV during the first 24 postoperative hours was significantly lower, according to a study by Shinn et al [28]. According to Yirmer et al, numerous studies have also demonstrated that 30 mg of intravenous propofol can reduce the incidence of PONV without causing any noticeable side effects [15] (Table 1). In addition, Celik et al found that 1 mg/kg/h of infusion of propofol is equally effective as dexamethasone for preventing PONV in patients undergoing laparoscopic cholecystectomy during the first 24 hours [29].…”

“…Rosillo-Menesesa et al demonstrated that propofol primarily acts on GABA receptors by increasing chloride ion conduction. Although the precise mechanism by which Propofol acts as an antiemetic remains elusive, it has been hypothesized that its antiemetic effects may be a result of the 5-HT3 receptor antagonist in the postrema region by gamma-aminobutyric acid (GABA) [15]. This makes it potentially effective for treating nausea and vomiting in the context of palliative care [10].…”