title: Vomiting after a pediatric adenotonsillectomy: comparison between propofol induced sevoflurane-nitrous oxide maintained anesthesia and TIVA with propofol-remifentanil.
abstract: BACKGROUND
  Anesthesia methods and drugs affect postoperative nausea and vomiting. Propofol is known to have antiemetic effects. We compared the incidence of postoperative vomiting (POV) in children undergoing an adenotonsillectomy; anesthesia in one group was induced with propofol and maintained with sevoflurane and nitrous oxide, and the other group received total intravenous anesthesia (TIVA) with propofol-remifentanil.
  
  
  METHODS
  Ninety children, ASA physical status I, were assigned randomly to one of two groups. In the PSN group, anesthesia was maintained with 2-3 vol% sevoflurane and 50% nitrous oxide. In the PR group, anesthesia was maintained with 10 mg/kg/h propofol and 0.25 µg/kg/min remifentanil. In both groups, anesthesia was induced with 0.5 µg /kg remifentanil and 2 mg/kg propofol. The incidence of POV and the need for rescue antiemetics were assessed in the postanesthesia care unit at 6, 12, and 24 hours postoperatively.
  
  
  RESULTS
  The total incidence of POV was not significantly different between the groups; POV occurred in eight (17.7%) and three (6.7%) children in the PSN and PR groups, respectively. Postoperative frequency of retching in the recovery room was significantly higher in the PSN group, with four children (8.9%) in the PSN group compared to none (0%) in the PR group (P = 0.041). The frequency of POV 24 hrs after exiting the recovery room tended to be higher in the PSN group than the PR group, but no statistically significant difference was observed.
  
  
  CONCLUSIONS
  If the development of POV in the early anesthetic recovery phase of children undergoing adenotonsillectomy is adequately prevented, propofol-induced anesthesia maintained with sevoflurane-nitrous oxide is as safe as TIVA with propofol-remifentanil.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Eulji University School of Medicine, Daejeon, Korea.
authors.forename: Ji-Hyun
authors.initials: JH
authors.lastname: Chung
authors.forename: Yoon-Hee
authors.initials: YH
authors.lastname: Kim
authors.forename: Young-Kwon
authors.initials: YK
authors.lastname: Ko
authors.forename: Sun-Yeul
authors.initials: SY
authors.lastname: Lee
authors.forename: Yoon-Tae
authors.initials: YT
authors.lastname: Nam
authors.forename: Seok-Hwa
authors.initials: SH
authors.lastname: Yoon