Comparison of a total intravenous anaesthetic technique using a propofol infusion, with an inhalational technique using enflurane for day case surgery

Price, Mary L.; Walmsley, A.; Swaine, C. N.; Ponte, J

doi:10.1111/j.1365-2044.1988.tb09081.x

Cited by 80 publications

(17 citation statements)

References 4 publications

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“…1,3,10,12,13 Our data supports the previously documented variability of prophylactic regimens, and therefore, does not demonstrate a bias among our anesthesia teams toward particular regimens. With 76% prevalence of PONV symptoms despite widespread (90%) use of well-recognized prophylaxis, these patients may be part of one of the most refractory to prophylaxis populations yet defined when compared globally to other surgical populations.…”

Section: Discussionsupporting

confidence: 88%

“…Less PONV in the early postoperative period is associated with total intravenous anesthesia with propofol, a known antiemetic, compared to inhalational agents. 10,12,13,27 Guideline-recommended antiemetic agents include serotonin (5-HT 3 ) receptor antagonists, dexamethosone, droperidol, phenothiazines, and transdermal scopolamine, and “high risk” patients (those with at least 2 risk factors) are expected to receive multimodal pharmacological perioperative prevention. 3,8,9 Yet specific combination preoperative and intraoperative regimens have not demonstrated relative superiority.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5][6][7] Many antiemetic prevention and treatment regimens have been studied and proven as efficacious. [8][9][10][11][12][13] However, patients express high levels of preoperative anxiety over potential PONV 5 most simply because PONV persists. 1,2 Multiple investigations into PONV have not translated reliably into clinically efficacious eradication of the disease.…”

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confidence: 99%

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Risk of severe and refractory postoperative nausea and vomiting in patients undergoing diep flap breast reconstruction

et al. 2013

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Background Postoperative nausea and vomiting (PONV) are commonly feared after general anesthesia and can impact results. The primary aim of our study was to examine incidence and severity of PONV by investigating complete response, or absence of PONV, to prophylaxis used in patients undergoing DIEP flaps. Our secondary aims were definition of the magnitude of risk, state of the art of interventions, clinical sequelae of PONV, and interaction between these variables, specifically for DIEP patients. Methods A retrospective chart review occurred for 29 patients undergoing DIEP flap breast reconstruction from September 2007 to February 2008. We assessed known patient and procedure-specific risks for PONV after DIEPs, prophylactic antiemetic regimens, incidence, and severity of PONV, postoperative antiemetic rescues, and effects of risks and treatments on symptoms. Results Three or more established risks existed in all patients, with up to seven risks per patient. Although 90% of patients received diverse prophylaxis, 76% of patients experienced PONV, and 66% experienced its severe form, emesis. Early PONV (73%) was frequent; symptoms were long lasting (average 20 hours for nausea and emesis); and multiple rescue medications were frequently required (55% for nausea, 58% for emesis). Length of surgery and nonsmoking statistically significantly impacted PONV. Conclusion We identify previously undocumented high risks for PONV in DIEP patients. High frequency, severity, and refractoriness of PONV occur despite standard prophylaxis. Plastic surgeons and anesthesiologists should further investigate methods to optimize PONV prophylaxis and treatment in DIEP flap patients.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Risk of severe and refractory postoperative nausea and vomiting in patients undergoing diep flap breast reconstruction

et al. 2013

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“…The use of propofol can be associated with less PONV or decreased requirements for antiemetic medication. [12] Antagonism of the dopamine D2 receptor by propofol has recently been suggested as a possible mechanism for this effect. [13] Visser et al .…”

Section: Discussionmentioning

confidence: 99%

Comparison of total intravenous anesthesia using propofol and inhalational anesthesia using isoflurane for controlled hypotension in functional endoscopic sinus surgery

Ankichetty

Ponniah

Cherian

et al. 2011

J Anaesthesiol Clin Pharmacol

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Background:An important requirement during functional endoscopic sinus surgery is to maintain a clear operative field to improve visualization during surgery and to minimize complications.Materials and Methods:We compared total intravenous anesthesia using propofol with inhalational anesthesia using isoflurane for controlled hypotension in functional endoscopic sinus surgery. It was a prospective study in a tertiary hospital in India. Forty ASA physical status I and II adult patients (16–60 years) were randomly allocated to one of two parallel groups (isoflurane group, n = 20; propofol group, n = 20). The primary outcome was to know whether total intravenous anesthesia using propofol was superior to inhalational anesthesia using isoflurane for controlled hypotension. The secondary outcomes measured were intraoperative blood loss, duration of surgery, surgeon's opinion regarding the surgical field and the incidence of complications.Results:The mean (±SD) time to achieve the target mean blood pressure was 18 (±8) minutes in the isoflurane group and 16 (±7) minutes in the propofol group (P = 0.66). There was no statistically significant difference (P = 0.402) between these two groups in terms of intraoperative blood loss and operative field conditions (P = 0.34).Conclusions:Controlled hypotension can be achieved equally and effectively with both propofol and isoflurane. Total intravenous anesthesia using propofol offers no significant advantage over isoflurane-based anesthetic technique in terms of operative conditions and blood loss.

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“…[83][84][85] In one study, this technique was equally efficacious to ondansetron 4 mg in the prevention of PONV (IIIA). 18 The antiemetic effect of propofol is most pronounced in the early postoperative period.…”

Section: B Propofolmentioning

confidence: 99%

Evidence-based management of postoperative nausea and vomiting: a review

Habib

Gan

2004

Can J Anesth/J Can Anesth

196

106

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P Pu ur rp po os se e: : To provide evidence-based guidelines for the prophylaxis and treatment of postoperative nausea and vomiting (PONV).S So ou ur rc ce e: : Literature from randomized controlled trials, systematic reviews, logistic regression analyses and expert opinion in the management of PONV.P Pr ri in nc ci ip pa al l f fi in nd di in ng gs s: : The etiology of PONV is multifactorial. Patient, anesthesia, and surgery related risk factors have been identified. Universal PONV prophylaxis is not cost-effective. Identification of patients at high-risk of PONV allows targeting prophylaxis to those who will benefit most from it. No prophylaxis is needed for patients at low risk for PONV. For patients at moderate risk for PONV, prophylaxis using a single antiemetic or a combination of two agents should be considered. Double and triple antiemetic combinations should be considered for patients at high risk for PONV. Furthermore, a multimodal approach should be adopted incorporating steps to keep the baseline risk of PONV low. The optimum cost-effective approach to the management of PONV will differ between an ambulatory centre and an inpatient hospital setting. For the treatment of established PONV in patients who failed prophylaxis, patients should not receive a repeat dose of the prophylactic antiemetic. Rather, a drug acting at a different receptor should be used. Beyond six hours after surgery, patients can be treated with any of the agents used for prophylaxis, except dexamethasone and transdermal scopolamine.C Co on nc cl lu us si io on n: : PONV are common after anesthesia and surgery. We provided evidence-based guidelines for the management of this problem based on the available literature. Objectif : Énoncer des lignes de conduite fondées sur des données probantes pour la prévention et le traitement des nausées et des vomissements postopératoires (NVPO). Source : Les publications d'essais contrôlés et randomisés, les études méthodiques, les analyses de régression logistique et l'opinion d'experts sur le traitement des NVPO. Constatations principales : L'origine des NVPO est multifactorielle. Les facteurs de risque reliés au patient, à l'anesthésie et au type de chirurgie sont connus. La prévention universelle des NVPO n'est pas rentable. L'identification des patients à haut risque de NVPO permet

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Comparison of a total intravenous anaesthetic technique using a propofol infusion, with an inhalational technique using enflurane for day case surgery

Cited by 80 publications

References 4 publications

Risk of severe and refractory postoperative nausea and vomiting in patients undergoing diep flap breast reconstruction

Risk of severe and refractory postoperative nausea and vomiting in patients undergoing diep flap breast reconstruction

Comparison of total intravenous anesthesia using propofol and inhalational anesthesia using isoflurane for controlled hypotension in functional endoscopic sinus surgery

Evidence-based management of postoperative nausea and vomiting: a review

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