Is Infusion of Subhypnotic Propofol as Effective as Dexamethasone in Prevention of Postoperative Nausea and Vomiting Related to Laparoscopic Cholecystectomy? A Randomized Controlled Trial

Abstract

Background. Postoperative nausea and vomiting (PONV) is one of common complications in patients undergoing laparoscopic cholecystectomy (LC). Aim of this study was to compare the efficacy of subhypnotic (1 mg/kg/h) infusion of propofol with dexamethasone on PONV in patients undergoing LC. Methods. A total of 120 patients were included in this randomized, double-blind, placebo-controlled study. Patients were randomly assigned to 3 groups; patients of group dexamethasone (group D) were administrated 8 mg dexamethasone before induction of anesthesia, patients of group propofol (group P) were infused to subhypnotic (1 mg/kg/h) propofol during operation and patients of group control (group C) were applied infusion of 10% intralipid. The incidence of PONV and needs for rescue analgesic and antiemetic were recorded in the first 24 h postoperatively. Results. In the 0–24 h, the incidence of PONV was significantly lower in the group D and group P compared with the group C (37.5%, 40%, and 72.5%, resp.). There was no significant difference in the incidence of PONV and use of antiemetics and analgesic between group D and group P. Conclusion. We concluded that infusion of propofol 1 mg/kg/h is as effective as dexamethasone for the prevention of PONV during the first 24 hours after anesthesia in patients undergoing LC.

Incidence and predictors of postoperative nausea and vomiting in children undergoing electrophysiology ablation procedures

“…Other studies have identified 15 mcg/kg/min, 60 mcg/kg/min, and 106 mcg/kg/min. 1,5,6 The median dose in our study was 25 mcg/kg/min with an interquartile range of 25-50 mcg/kg/min. It would likely require a prospective dose finding study to identify the minimum propofol dose necessary to provide benefit.…”

“…The use of a low‐dose or subhypnotic propofol infusion has been described in the pediatric literature in patients undergoing tonsillectomy and in adults undergoing laparoscopic cholecystectomy . It is notable that our rate of vomiting in the recovery room was low for the overall group (7.4%) and even lower for the patients who received a subhypnotic propofol infusion compared to the nonpropofol group (4.9% vs. 11.7%, P < .002).…”

“…We were unable to quantify the dose of propofol required to decrease the incidence of vomiting. Other studies have identified 15 mcg/kg/min, 60 mcg/kg/min, and 106 mcg/kg/min . The median dose in our study was 25 mcg/kg/min with an interquartile range of 25‐50 mcg/kg/min.…”

Assessment of pre‐operative maropitant citrate use in macaque (Macaca fasicularis & Macaca mulatta) neurosurgical procedures

“…41 Propofol in sub-hypnotic doses has been shown to be an effective antiemetic against chemotherapy and PONV when used as a continuous rate infusion. 3,17,19,21,41 For procedures that last longer than 60 minutes, induction doses of propofol are not shown to have any antiemetic effects in humans. 42 when propofol is substituted for inhalational anesthesia in humans, the risk for PONV is decreased, but only by approximately one-fifth, suggesting there are other causes of PONV following general anesthesia.…”

“…8 Numerous agents and pre-operative precautions have been used to prevent or symptomatically treat PONV in humans. 1,3,4,9 Although human medicine often includes pharmaceutical intervention to reduce this risk, [1][2][3][4]9,[17][18][19][20][21] this is not common practice in NHP anesthetic protocols.…”