Propofol-based total intravenous anesthesia decreases the incidence of postoperative nausea and vomiting without affecting flap survival in free flap breast reconstruction

Abstract

Background: Postoperative nausea and vomiting (PONV) may cause undesirable effects after microsurgical breast reconstruction. Although total intravenous anesthesia (TIVA) with propofol has been demonstrated to be effective in reducing PONV, it has not been assessed in autologous free flap breast reconstruction. The purpose of this study was to investigate the antiemetic prophylaxis effect and safety of TIVA in microvascular breast reconstruction.Methods: Eighty-three patients undergoing microsurgical breast reconstruction with propofol (31 patients) or sevoflurane (52 patients) were retrospectively reviewed. The incidence of PONV was assessed at 2, 6, and 24 hours after surgery. Mean arterial blood pressure (MAP) was compared at T 1 (after flap elevation but before transfer), T 2 (15 minutes after revascularization), and T 3 (at the end of surgery).Results: The incidence of nausea was significantly reduced in the TIVA group over 0 to 2 hours period (P=0.017), and over 2 to 6 hours period (P=0.033). The incidence of vomiting was significantly reduced in the TIVA group over 0 to 2 hours period (P=0.006), and over 2 to 6 hours period (P=0.005). MAP was higher in the TIVA group at T 1 (P=0.018), T 2 (P=0.005), and T 3 (P=0.007). The incidence of flap failure was similar between the two groups (P=0.373).Conclusions: Compared with sevoflurane maintaining anesthesia, propofol-based TIVA improves PONV with less fluctuation of MAP, and did not affect flap survival.

Comparison of Remimazolam versus Sevoflurane on the Postoperative Quality of Recovery in Cervical Spine Surgery: A Prospective Randomized Controlled Double-Blind Trial

“…In addition, the use of benzodiazepines as anxiolytic agents for premedication also seems to support the findings of this study showing stable psychological results after surgery in group R. The score for nausea and vomiting was significantly better in group R than in group S. Moreover, the NRS score of PONV severity measured in the ward within 6 and 24 h after surgery was also statistically significantly lower in patients in group R, which is in line with the results of previous studies showing that PONV reduction is significantly greater in propofol-based TIVA than in inhalation anesthesia. 28,29 This is because benzodiazepine-like drugs have antiemetic properties and inhalational anesthetics stimulate the vagal nerve and affect the vestibular system, thus causing nausea. 25,30 Another specific finding is that although postoperative 1-6 h rescue analgesia was higher in group R, there was no difference in the QoR-15 pain score on POD 1.…”

Less use of rescue morphine when a combined PSP/IPP-block is used for postoperative analgesia in breast cancer surgery

“…anaesthesia has been shown to lessen the risk of PONV. 13,14 It is reasonable to administer a small dose of morphine before emergence from anaesthesia if remifentanil has been used as the principal peri-operative analgesic and no regional anaesthetic is administered. 15 In earlier studies, the poor control group pain management tended to act synergistically to produce levels of postoperative pain and/or PONV above a reasonable standard for modern anaesthesia.…”

“…Furthermore, total i.v. anaesthesia has been shown to lessen the risk of PONV 13,14 . It is reasonable to administer a small dose of morphine before emergence from anaesthesia if remifentanil has been used as the principal peri-operative analgesic and no regional anaesthetic is administered 15 .…”

Analysis of influencing factors and construction of prediction model for postoperative nausea and vomiting in patients undergoing laparoscopic sleeve gastrectomy: a single-center retrospective cohort study

“…It is possible that sevo urane increases the occurrence of nausea and vomiting by modulating motilin production. On the other hand, propofol possesses certain antiemetic properties, possibly by mediating γaminobutyric acid receptors, leading to a decrease in serotonin (5-HT) concentration and inhibiting the chemical receptor vagus nucleus, thereby producing an antiemetic effect [17].…”