British Journal of Anaesthesia, Vol 77, Issue 4 463-467, Copyright © 1996 by The Board of Management and Trustees of the British Journal of Anaesthesia
P. Ewalenko, S. Janny, M. Dejonckheere, G. Andry and C. Wyns
Postoperative nausea and vomiting (PONV) are unpleasant, often
underestimated side effects of anaesthesia and surgery, not devoid of
medical complications. Prevention with antiemetics is only partially
effective. Propofol has been shown recently to possess antiemetic
properties in several situations. In this prospective, randomized,
controlled trial, we have compared the antiemetic efficacy of subhypnotic
doses of propofol, with Intralipid as placebo, after thyroidectomy. We
studied 64 patients of both sexes, aged 22-71 yr, ASA I or II, undergoing
thyroidectomy. After premedication with a benzodiazepine, balanced
anaesthesia was produced with isoflurane and nitrous oxide in oxygen, and
supplementary analgesia with fentanyl i.v. as required. Postoperative
analgesia was provided with non-opioids, and piritramide 0.25 mg kg-1 i.m.
on demand. Patients were allocated randomly and blindly to receive a 20-h
infusion of either propofol or 10% Intralipid 0.1 ml kg-1 h-1. Intralipid,
the excipient of propofol, was chosen as placebo as it is devoid of
antiemetic effects. Sedation scores, respiratory and cardiovascular
variables, and incidence of PONV were assessed every 4 h for 24 h. Pulse
oximetry and ECG were monitored continuously. Both groups were comparable
in characteristics, surgical and anaesthesia procedures, amount of opioids
given during and after operation, and total amount of the study drug
infused after operation. Occurrence of PONV was similar before the start
(propofol 41%, Intralipid 50%) and after completion (propofol 0.64%,
Intralipid 1.6%) of infusion and decreased with time in both groups during
the infusion. However, symptoms were reduced to nil with propofol but
persisted and were more severe with Intralipid during infusion (P < or =
0.01). The overall incidence of PONV during infusion was 10% (three of 32
patients) in the propofol group and 65% (21 of 32 patients) in the
Intralipid group. Cardiovascular and respiratory variables, and SpO2 were
unaltered, and sedation decreased similarly with time in both groups. We
conclude that propofol, given at subhypnotic doses, effectively reduced the
incidence of PONV without untoward sedative or cardiovascular effects.
CLINICAL INVESTIGATIONS
Antiemetic effect of subhypnotic doses of propofol after thyroidectomy
Department of Anaesthesia and Intensive Care, Institut Jules Bordet, Tumour Centre of the Brussels Free University, Brussels, Belgium; Department of Surgery, Institut Jules Bordet, Tumour Centre of the Brussels Free University, Brussels, Belgium; Department of Anaesthesia and Intensive Care, and Department of Surgery, Institut Jules Bordet, Tumour Centre of the Brussels Free University, Brussels, Belgium
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