Postoperative nausea and vomiting after mastoidectomy with tympanoplasty: a comparison between TIVA with propofol-remifentanil and balanced anesthesia with sevoflurane-remifentanil

Abstract

BackgroundThere is growing interest in the anesthetic approach using total intravenous anesthesia (TIVA) with propofol and remifentanil for the prevention of postoperative nausea and vomiting (PONV). The aim of this study was to compare between the two anesthetic techniques for preventing PONV in the patients undergoing mastoidectomy with tympanoplasty.MethodsAfter obtaining informed consent, 62 patients aged between 20 to 60 years undergoing elective mastoidectomy and tympanoplasty were randomized into two equal study groups: group P/R (n = 31) included patients undergoing TIVA with propofol and remifentanil, and group S/R (n = 31) included patients undergoing balanced anesthesia with sevoflurane and remifentanil. The incidences of PONV and complete response (no PONV, no rescue) were assessed at 1 and 24 h after surgery, using the Rhodes Index. Also, the usage of rescue antiemetics and pain intensity were recorded.ResultsThe Rhodes Index including the occurrence score, distress score and experience score was significantly lower in the P/R group compared to that in the S/R group during the study period (P < 0.05), and the incidence of complete response was significantly higher in the P/R group compared to that in the S/R group, during the first 24 h after surgery. 4 patients in the S/R group requested antiemetics during the first 1 h after surgery. There were no significant differences in pain intensity among groups.ConclusionsCompared to balanced anesthesia with sevoflurane and remifentanil, TIVA with propofol and remifentanil was followed by significantly lower incidence and severity of PONV.

A comparison of sedation with midazolam–ketamine versus propofol–fentanyl during endoscopy in children: a randomized trial

“…In our study without prophylactic atropine, nausea was found in 62.2% of the patients in the midazolam–ketamine group and vomiting was found in 33.6% of these patients, which is higher than the findings of previous studies. Propofol has been shown to have antiemetic effects in different surgical procedures 40–43. In our study, significantly less nausea and vomiting was also observed in the fentanyl–propofol group.…”

Effects of intra‐operative maintenance of general anaesthesia with propofol on postoperative pain outcomes – a systematic review and meta‐analysis

“…A total of 13 trials reported pain intensity at or around 2 h postsurgery, in which 686 patients received anaesthesia using propofol for maintenance, while 668 were given inhalational anaesthesia [10,11,[18][19][20][21][22][23][24][25][26][27][28]. Overall, pain scores were not significantly different between experimental groups (Hedge's g (95%CI) À0.120 (À0.415-0.175) (p = 0.425) (Fig.…”

“…A total of nine trials reported pain intensity at or around 24 h postsurgery, in which 595 patients received propofol anaesthesia, while 586 had inhalational anaesthesia [10,11,18,19,21,22,25,28,29]. Overall, compared with inhalational anaesthetics, patients who received propofol reported significantly lower pain scores 24 h postsurgery (Hedge's g (95% CI) À0.134 (À0.248 to À0.021) (p = 0.021) (Fig.…”

“…Eight studies investigated postoperative nausea and vomiting, with 371 patients receiving propofol and 354 patients receiving inhalational anaesthesia [10,19,20,22,24,25,28,30]. Propofol was associated with a significant reduction in postoperative nausea and vomiting (relative risk (95% CI) 0.446 (0.304-0.656) (p < 0.0001) (Fig.…”

General anesthesia versus monitored anesthetic care with dexmedetomidine for closed reduction of nasal bone fracture

“…However, in our research, there was no significant difference in the percentage of postoperative nausea and vomiting between the two groups. This is believed to be attributed to the short operation and anesthesia time because the intubation time was shorter and a reduced amount of inhalation anesthesia was used [16,17]. …”