Incidence of postoperative nausea and vomiting is not increased by combination of low concentration sevoflurane and propofol compared with propofol alone in patients undergoing laparoscopic gynecological surgery

Abstract

Background: The incidence of postoperative nausea and vomiting (PONV) is higher in patients receiving volatile anesthetics than those receiving total intravenous anesthesia (TIVA) with propofol. However, it is unclear whether its incidence is increased when a low concentration of sevoflurane is used in combination with propofol. Methods: This prospective, randomized, controlled trial enrolled women undergoing laparoscopic gynecological surgery. Patients were randomly assigned to receive general anesthesia either with propofol alone (group P) or with 0.8% sevoflurane and propofol (group SP, n = 36, each group) for maintenance of anesthesia. The incidence of PONV and the number of patients who required antiemetics were compared. Results: There were no differences in the incidence of PONV and the number of patients who required antiemetics between the P and SP groups. Conclusions: A combination of 0.8% sevoflurane and propofol to maintain anesthesia does not increase the incidence of PONV compared with TIVA with propofol.

Effect of Propofol Infusion on Need for Rescue Antiemetics in Postanesthesia Care Unit After Volatile Anesthesia: A Retrospective Cohort Study

“…25 The mechanism by which propofol may modulate the risk of PONV is not well understood. 11,26,27 Propofol infusions could have a direct antiemetic effect, could decrease the dose of volatile anesthetics needed to maintain anesthesia, 11,13,14 or both.…”

“…For example, use of propofol with a low sevoflurane concentration (0.8%) does not increase the incidence of PONV compared with total intravenous anesthesia with propofol. 11 In another study, the PONV rate was lower in patients receiving a combination of sevoflurane and propofol versus sevoflurane alone. 12 Adding a propofol infusion to volatile anesthesia theoretically provides 2 benefits: 1) since volatile agents are associated with PONV and use of propofol may allow for decreasing the concentration of volatile agents, [13][14][15] the rate of PONV may be expected to be reduced; and 2) by simultaneously using lower doses of 2 anesthetics with different elimination pathways, recovery room stay may be shortened.…”

Comparison of the Effects of Propofol and Sevoflurane Anesthesia on Optic Nerve Sheath Diameter in Robot-Assisted Laparoscopic Gynecology Surgery: A Randomized Controlled Trial

“…During laparoscopic surgeries in the Trendelenburg position, increased ONSD as a surrogate parameter of ICP is highly correlated with the occurrence of PONV [28]. Other factors, including female and anesthetic technique, increase the risk of PONV [29]. In this study, two patients from the Sevoflurane group experienced PONV even though they were administered antiemetics, but these occurrences were not statistically significant.…”

Inhalation of low-dose desflurane prevents the hemodynamic instability caused by target-controlled infusion of remifentanil and propofol during laparoscopic gynecological surgery: A randomized controlled trial

“…Firstly, although the power analysis indicated that the number of patients who were required in the present study was sufficient, the population size was relatively small and this was a singlecenter study. This may be an underlying reason explaining statistically non-significant differences in postoperative adverse reactions between the PRD and PR groups and the lower PONV observed (1/30 patients, 3.3%) compared with previous reports (20-50%) (4,31,32). Secondly, the enrolled patients were relatively young and whether the conclusion is similar in an older population requires further validation.…”