The Use of Propofol as an Antiemetic

DeBalli, Peter

doi:10.1097/00004311-200341040-00007

Cited by 26 publications

(11 citation statements)

References 38 publications

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“…Karanicolas et al [19] in a meta-analysis of 17 trials found that dexamethasone reduced the incidence of postoperative nausea by 41%, vomiting 59% and nausea or vomiting 45% [19]. Regarding metoclopramide, although there is a lack of evidence for antiemetic efficacy, it has been found that it is useful in preventing the delayed gastric emptying caused by opioids due to its ability to promote gastric motility [20]. In our study the concept was to try to minimize immediate as well as delayed PONV and to improve patients' satisfaction.…”

Section: Discussionmentioning

confidence: 99%

Breast Augmentation: Reducing Postoperative Nausea and Vomiting. A Prospective Study

Keramidas¹,

Vasileiou²,

Pascovitis³

et al. 2017

JACCOA

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Background: Breast augmentation is the plastic surgery procedure associated with the greatest risk of postoperative nausea and vomiting (PONV). The purpose of this study is to evaluate the efficacy of a specific antiemetic protocol applied in breast augmentation in order to diminish the incidence of PONV Methods: A prospective-level of evidence II-study was performed in 247 patients that underwent breast augmentation from October 2010 to October 2014. General anesthesia was induced with propofol, fentanyl and rocuronium. Anesthetic maintenance was accomplished with total intravenous anesthesia and air with oxygen at 50%. All patients received metoclopramide 10 mg intravenously (iv) and 8 mg of ondasetron iv (2 mg at the induction and 6 mg over 30 minutes). Intergroup comparison of means was performed using unpaired t tests and analysis of variance, where applicable.Results: Nausea and emesis occurred with an overall frequency of 4.9% and 2.8% respectively. The 95.1 percent of the patient didn't complaint having nausea on the day of operation, and only 3 (1.2%) of them had this symptom remaining until the fifth post op day. Only 7 patients reported vomiting on the day of the operation. There is no significant difference in nausea between smokers and no smokers (p= 0.510). Conclusion:Τhe specific antiemetic protocol applied in breast augmentation operations seems to be highly effective. The fact that we observed no difference between smokers and nonsmokers regarding the incidence of PONV should be further investigated since till now a protective role for smoking against PONV was suggested. Introduction 1Postoperative nausea and vomiting (PONV) are common adverse effects that occur after several types of surgical procedures. The general incidence of vomiting is about 30%, the incidence of nausea is about 50%, and in high-risk patients, the PONV rate can be as high as 80% [1][2][3]. The mechanism of PONV is multifactorial and not well-deciphered. The emesis reflex is coordinated by the vomiting center, located in the hindbrain within the medulla oblongata in close proximity to the chemoreceptor trigger zone within the area postrema. Stimuli from peripheral organs and tissues, including the genitalia are transmitted to the vomiting center by the afferent neurons of the vagus nerve [4].However, not all patients have the same risk profile for PONV. The incidence of PONV varies with patient-related factors, the nature of surgery performed, type of anesthesia used, and duration of surgery and perioperative management of the patient (Table 1) [5]. The risk of PONV in adult women has been found to be two to three times greater than in adult men. Progesterone 1 Presented:1) The 12th Congress of the ESPRAS -July 6-11, 2014, Edinburgh, Scotland.2) 22nd Congress of the ISAPS -September 19-22, 2014 Rio de Janeiro, Brazil.3) Accepted for presentation in Euroanaesthesia 2016 London UK May 28-30. or serum gonadotropin seem to be the contributing factor in the higher incidence of PONV in women [5,6]. Furthermore, obese p...

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Section: Discussionmentioning

confidence: 99%

Breast Augmentation: Reducing Postoperative Nausea and Vomiting. A Prospective Study

Keramidas¹,

Vasileiou²,

Pascovitis³

et al. 2017

JACCOA

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“…In addition, White et al [14] reported that because TIVA reduced the predicted rate of PONV in the early postoperative period only, a long-acting antiemetic drug might be necessary to prevent postdischarge nausea and vomiting in day-case surgery. It has been shown that a minimum plasma concentration of propofol is necessary to produce an antiemetic effect [23]. Since propofol has a short, context-sensitive half-time (less than 40 min for infusions up to 8 h), significant plasma-levels would be unlikely after several hours.…”

Section: Discussionmentioning

confidence: 99%

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

Lee

Jeong

et al. 2011

Korean J Anesthesiol

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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.

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“…), and since it has a short half-life, therapeutic anti-emetic plasma levels are unlikely to persist after several hours [53]. Propofol may provide prophylaxis against early PONV only, and suitable strategies should be planned for patients after discharge.…”

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confidence: 99%

A comparison of total intravenous anaesthesia using propofol with sevoflurane or desflurane in ambulatory surgery: systematic review and meta‐analysis

et al. 2014

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SummaryWith the popularity of ambulatory surgery ever increasing, we carried out a systematic review and meta-analysis to determine whether the type of anaesthesia used had any bearing on patient outcomes. Total intravenous propofol anaesthesia was compared with two of the newer inhalational agents, sevoflurane and desflurane. In total, 18 trials were identified; only trials where nitrous oxide was administered to, or omitted from, both groups were included. A total of 1621 patients were randomly assigned to either propofol (685 patients) or inhalational anaesthesia (936 patients). If surgical causes of unplanned admissions were excluded, there was no difference in unplanned admission to hospital between propofol and inhalational anaesthesia (1.0% vs 2.9%, respectively; p = 0.13). The incidence of postoperative nausea and vomiting was lower with propofol than with inhalational agents (13.8% vs 29.2%, respectively; p < 0.001). However, no difference was noted in post-discharge nausea and vomiting (23.9% vs 20.8%, respectively; p = 0.26). Length of hospital stay was shorter with propofol, but the difference was only 14 min on average. The use of propofol was also more expensive, with a mean (95% CI) difference of £6.72 (£5.13-£8.31 (€8.16 (€6.23À€10.09); $11.29 ($8.62-$13.96))) per patient-anaesthetic episode (p < 0.001). Therefore, based on the published evidence to date, maintenance of anaesthesia using propofol appeared to have no bearing on the incidence of unplanned admission to hospital and was more expensive, but was associated with a decreased incidence of early postoperative nausea and vomiting compared with sevoflurane or desflurane in patients undergoing ambulatory surgery.

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The Use of Propofol as an Antiemetic

Cited by 26 publications

References 38 publications

Breast Augmentation: Reducing Postoperative Nausea and Vomiting. A Prospective Study

Breast Augmentation: Reducing Postoperative Nausea and Vomiting. A Prospective Study

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

A comparison of total intravenous anaesthesia using propofol with sevoflurane or desflurane in ambulatory surgery: systematic review and meta‐analysis

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