Post-operative nausea and vomiting in out-patient gynecologic laparoscopy: a comparison of thiopental-nitrous oxide, propofol-nitrous oxide and total intravenous anesthesia using propofol.
An intravenous anesthetic drug, propofol was considered to pose antiemetic action. A randomized controlled trial was conducted to evaluate whether propofol could effectively reduce post-operative nausea and vomiting (PONV) compared to thiopental-nitrous oxide (N2O). One-hundred and eight patients undergoing outpatient gynecologic laparoscopy were assigned to receive 3 techniques of anesthesia; thiopental-N2O (T/N), propofol-N2O (P/N) and total intravenous anesthesia (TIVA) using propofol (P/P). The results showed that in the early period (0-5 hours), post-operative nausea in T/N, P/N and P/P groups was 72 per cent, 44 per cent and 31 per cent, respectively (P = 0.002), and post-operative vomiting was 58 per cent, 36 per cent and 11 per cent respectively (P = 0.00014). Patients in the P/N and P/P groups experienced nausea less frequently than the T/N group [relative risk (RR) = 0.62, (95% CI 0.41-0.93) and RR = 0.42 (0.25-0.72) respectively]. Patients in the P/N and P/P groups experienced vomiting less frequently than the T/N group [RR = 0.62 (0.37-1.04) and RR = 0.19 (0.07-0.5) respectively]. Two patients in the T/N group were admitted because of severe nausea and vomiting. In conclusion, TIVA using propofol and propofol-N2O anesthesia can significantly reduce the incidence of PONV in the early period. Concerning the economic crisis of the country as well as the quality of care, propofol-N2O would be the most appropriate anesthetic of choice.
Chanvej
L
L
Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
Kijsirikul
S
S
Thongsuksai
P
P
Naheem
L
L
D000328:Adult; D000704:Analysis of Variance; D000769:Anesthesia, Inhalation; D019162:Anesthetics, Combined; D018685:Anesthetics, Inhalation / Q000494:pharmacology*; D018686:Anesthetics, Intravenous / Q000494:pharmacology*; D000932:Antiemetics / Q000494:pharmacology*; D016009:Chi-Square Distribution; D005260:Female; D005831:Genital Diseases, Female / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D009609:Nitrous Oxide / Q000494:pharmacology*; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control*; D015742:Propofol / Q000494:pharmacology*; D012306:Risk; D018709:Statistics, Nonparametric; D013874:Thiopental / Q000494:pharmacology*; D016896:Treatment Outcome
D019162:Anesthetics, Combined; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D000932:Antiemetics; D013874:Thiopental; D009609:Nitrous Oxide; D015742:Propofol