Prevention of
Postoperative Nausea and Vomiting by Continuous Infusion of Subhypnotic
Propofol in Female Patients receiving
Intravenous Patient-Controlled Analgesia.
Soon Im Kim and Sun Chong Kim
Department of
Anesthesiology, Soonchunhyang University Hospital,
657 Hannam-Dong,
Yongsan-Ku, Seoul, Korea.
Introduction: Propofol is associated with a low
incidence of postoperative nausea and vomiting (PONV). In this prospective, randomized, double
blind, placebo-controlled study, we investigated the possible preventive
antiemetic properties of continuous subhypnotic infusion of propofol in
fentanyl intravenous patient-controlled analgesia (IV-PCA) during the first 24
h after surgery.
Methods: One hundred ASA I or II female patients,
aged 20-71 yr, after major gynecological or orthopedic surgery, were included.
In the recovery room, all patients received fentanyl IV-PCA for pain relief.
The patients were randomly received one of five infusion regimens using an
another PCA pump for 24 h as follows; intralipid as a placebo, and propofol 5,
10, 15, and 20 mg kg-1 min-1. The incidence of
PONV, sedation scores, and other side effects were evaluated.
Results: The incidences of PONV during the first 24
hours after operation are summarized in the Table:
|
|
|
Propofol |
||||
|
|
Placebo (n=20) |
5 mg (n=20) |
10 mg (n=20) |
15 mg (n=20) |
20 mg (n=20) |
|
|
No Symptoms |
5(25) |
8(40) |
9(45) |
13(65)* |
14(70) * |
|
|
Nausea only |
4(20) |
6(30) |
8(40) |
3(15) |
5(25) |
|
|
Vomiting |
11(55) |
6(30) |
3(15) |
4(20) |
1(5) |
|
Values are numbers (%), * P< 0.05 vs. placebo.
The patients infused with propofol 20 mg kg-1 min-1
reported more sedation compared to those with placebo group at 4 hr
postoperatively (P < 0.05).
Conclusion: We conclude that continuous subhypnotic infusion of
propofol in the dose of 15 and 20 mg kg-1 min-1 prevents
PONV for the patients with fentanyl IV-PCA effectively. Infusion rate of 15 mg kg-1 min-1 seems to
be optimal dose with minimal side effects.
References: 1) Ewalenko P, et al. Br J Anaesth 1996; 77:
463-7. 2) Montgomery JE,
et al. Anaesthesia 1996; 51: 554-7.