Propofol anaesthesia and postoperative nausea and vomiting: quantitative systematic review of randomized controlled studies.

Tramèr, Martin R.; Moore, Alastair; McQuay, Henry J

doi:10.1093/bja/78.3.247

Cited by 273 publications

(128 citation statements)

References 80 publications

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“…The direction of the treatment effect in favour of propofol ⁄ propofol is supported by the literature. PONV incidence in the trial is at the low end of the reported range [19][20][21][22]. The direction of the treatment effect in favour of propofol ⁄ propofol is supported by the literature.…”

Section: Discussionsupporting

confidence: 54%

Clinical and economic choices in anaesthesia for day surgery: A prospective randomised controlled trial

Elliott

Payne

Moore³

et al. 2003

Anaesthesia

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SummaryWe compared the cost-effectiveness of general anaesthetic agents in adult and paediatric day surgery populations. We randomly assigned 1063 adult and 322 paediatric elective patients to one of four (adult) or two (paediatric) anaesthesia groups. Total costs were calculated from individual patient resource use to 7 days post discharge. Incremental cost-effectiveness ratios were expressed as cost per episode of postoperative nausea and vomiting (PONV) avoided. In adults, variable secondary care costs were higher for propofol induction and propofol maintenance (propofol ⁄ propofol; p < 0.01) than other groups and lower in propofol induction and isoflurane maintenance (propofol ⁄ isoflurane; p < 0.01). In both studies, predischarge PONV was higher if sevoflurane ⁄ sevoflurane (p < 0.01) was used compared with use of propofol for induction. In both studies, there was no difference in postdischarge outcomes at Day 7. Sevoflurane ⁄ sevoflurane was more costly with higher PONV rates in both studies. In adults, the cost per extra episode of PONV avoided was £296 (propofol ⁄ propofol vs. propofol ⁄ sevoflurane) and £333 (propofol ⁄ sevoflurane vs. propofol ⁄ isoflurane).

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Section: Discussionsupporting

confidence: 54%

Clinical and economic choices in anaesthesia for day surgery: A prospective randomised controlled trial

Elliott

Payne

Moore³

et al. 2003

Anaesthesia

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“…It is not useful for PONV prophylaxis if given only as a bolus for induction of anesthesia (IIA). 36 More recently, continuous subhypnotic propofol infusion and the use of patient-controlled antiemesis with propofol were also found to be effective in the treatment of PONV (IIIA). 86,87 The effective plasma concentration of propofol for the 50% reduction in nausea scores has been found to be 343 ng·mL -1 .…”

Section: B Propofolmentioning

confidence: 99%

“…15 TIVA with propofol has been shown to reduce the incidence of PONV, especially in the early postoperative period. 36 Avoidance of nitrous oxide (which increases postoperative vomiting) and volatile agents (which cause PONV for up to two hours postoperatively), and minimizing intraoperative and postoperative opiates, also reduce the incidence of PONV. 2,[8][9][10][11][12][13] The use of large doses of neostigmine (> 2.5 mg) increases the risk of PONV.…”

Section: Combination Antiemetic Therapy and Multimodal Approachmentioning

confidence: 99%

“…The available options for PONV prophylaxis are presented in Table III. A number of antiemetic interventions have been studied in systematic reviews. 9,14,[29][30][31][32][33][34][35][36][37][38] As a measure of antiemetic efficacy, the number needed-to-treat (NNT) is calculated. In this context, the NNT indicates the number of patients needed to receive a particular antiemetic intervention to prevent one emetic event that would have occurred had the patient not received the intervention.…”

mentioning

confidence: 99%

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Evidence-based management of postoperative nausea and vomiting: a review

Habib

Gan

2004

Can J Anesth/J Can Anesth

196

106

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P Pu ur rp po os se e: : To provide evidence-based guidelines for the prophylaxis and treatment of postoperative nausea and vomiting (PONV).S So ou ur rc ce e: : Literature from randomized controlled trials, systematic reviews, logistic regression analyses and expert opinion in the management of PONV.P Pr ri in nc ci ip pa al l f fi in nd di in ng gs s: : The etiology of PONV is multifactorial. Patient, anesthesia, and surgery related risk factors have been identified. Universal PONV prophylaxis is not cost-effective. Identification of patients at high-risk of PONV allows targeting prophylaxis to those who will benefit most from it. No prophylaxis is needed for patients at low risk for PONV. For patients at moderate risk for PONV, prophylaxis using a single antiemetic or a combination of two agents should be considered. Double and triple antiemetic combinations should be considered for patients at high risk for PONV. Furthermore, a multimodal approach should be adopted incorporating steps to keep the baseline risk of PONV low. The optimum cost-effective approach to the management of PONV will differ between an ambulatory centre and an inpatient hospital setting. For the treatment of established PONV in patients who failed prophylaxis, patients should not receive a repeat dose of the prophylactic antiemetic. Rather, a drug acting at a different receptor should be used. Beyond six hours after surgery, patients can be treated with any of the agents used for prophylaxis, except dexamethasone and transdermal scopolamine.C Co on nc cl lu us si io on n: : PONV are common after anesthesia and surgery. We provided evidence-based guidelines for the management of this problem based on the available literature. Objectif : Énoncer des lignes de conduite fondées sur des données probantes pour la prévention et le traitement des nausées et des vomissements postopératoires (NVPO). Source : Les publications d'essais contrôlés et randomisés, les études méthodiques, les analyses de régression logistique et l'opinion d'experts sur le traitement des NVPO. Constatations principales : L'origine des NVPO est multifactorielle. Les facteurs de risque reliés au patient, à l'anesthésie et au type de chirurgie sont connus. La prévention universelle des NVPO n'est pas rentable. L'identification des patients à haut risque de NVPO permet

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“…12 In most meta-analyses, propofol was associated with a lower frequency of PONV when used for total iv anesthesia in the absence of N 2 O. [12][13][14][15] In one meta-analysis, the rate of PONV was lower with the use of any propofol when compared with sevoflurane. 16 The omission of anticholinesterases (for reversal of muscle relaxation) also reduced PONV but also resulted in an increased risk of clinically relevant residual muscle weakness.…”

Section: Résultats : Aucune Différence Intergroupe N'a éTé Enregistrémentioning

confidence: 99%

Induction with sevoflurane-remifentanil is comparable to propofol-fentanyl-rocuronium in PONV after laparoscopic surgery

Yang

Choi

McChesney

et al. 2004

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : To compare sevoflurane-remifentanil induction and propofol-fentanyl-rocuronium induction with regards to the frequency of moderate to severe postoperative nausea and vomiting (PONV) in the first 24 hr after laparoscopic day surgery.M Me et th ho od ds s: : After informed consent, 156 ASA physical status class I to III patients undergoing laparoscopic cholecystectomy or tubal ligation were randomized to either induction with sevoflurane 8%, N 2 O 67% and iv remifentanil 1 to 1.5 µg·kg -1 or induction with iv fentanyl 2 to 3 µg·kg -1 , propofol 2 mg·kg -1 , and rocuronium 0.3 to 0.5 mg·kg -1 . All patients received iv ketorolac 0.5 mg·kg -1 at induction and sevoflurane-N 2 O maintenance anesthesia with rocuronium as needed. PONV was treated with iv ondansetron, droperidol, or dimenhydrinate; postoperative pain was treated with opioid analgesics. Patients were followed for 24 hr with regards to PONV and pain. Intubating conditions, induction and emergence times, time to achieve fast-track discharge criteria, and drug costs were measured. R Re es su ul lt ts s: : No differences were seen between the two groups in their frequencies of 24-hr moderate to severe PONV and postoperative pain, or in their intubating conditions, induction and emergence times, and time to achieve fast-track discharge criteria. Patients undergoing sevoflurane-remifentanil induction received more morphine (11 mg vs 8 mg; P < 0.001) in the postanesthetic care unit. Sevoflurane-remifentanil induction resulted in similar anesthetic and total drug costs for both procedures.C Co on nc cl lu us si io on n: : We did not demonstrate any difference in PONV, pain, or anesthetic/recovery times or costs between the sevoflurane and propofol groups. Sevoflurane-remifentanil induction is a feasible technique for anesthetic induction. Objectif : Comparer l'induction avec sévoflurane-rémifentanil ou propofol-fentanyl-rocuronium quant à la fréquence de nausées et vomissements postopératoires (NVPO) de modérés à sévères pendant les 24 premières heures après une opération en chirurgie d'un jour sous laparoscopie. Méthode : Après avoir accordé leur consentement, 156 patients d'état

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Propofol anaesthesia and postoperative nausea and vomiting: quantitative systematic review of randomized controlled studies.

Cited by 273 publications

References 80 publications

Clinical and economic choices in anaesthesia for day surgery: A prospective randomised controlled trial

Clinical and economic choices in anaesthesia for day surgery: A prospective randomised controlled trial

Evidence-based management of postoperative nausea and vomiting: a review

Induction with sevoflurane-remifentanil is comparable to propofol-fentanyl-rocuronium in PONV after laparoscopic surgery

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