Propofol/remifentanil <i>vs</i> sevoflurane/remifentanil for long lasting surgical procedures: a randomised controlled trial

Höcker, Jan; Tonner, Peter H.; Böllert, P.; Paris, Andrea; Scholz, Jens; Meier-Paika, C.; Bein, Berthold

doi:10.1111/j.1365-2044.2006.04715.x

Cited by 24 publications

(18 citation statements)

References 27 publications

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“…Total intravenous anesthesia with propofol and remifentanil did not reduce the incidence of PONV, although propofol is generally assumed to be antiemetic. Some reports have demonstrated that propofol with opioid did not reduce the incidence of PONV compared to balanced anesthesia with opioid 16,17,18,19. Longer duration of anesthesia was identified as a risk factor for PONV, similar to the previous study 3,20,21,22.…”

Section: Discussionsupporting

confidence: 77%

Incidence and Risk Factors of Postoperative Nausea and Vomiting in Patients with Fentanyl-Based Intravenous Patient-Controlled Analgesia and Single Antiemetic Prophylaxis

et al. 2014

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PurposeWe evaluated the incidence and risk factors of postoperative nausea and vomiting (PONV) in patients with fentanyl-based intravenous patient-controlled analgesia (IV-PCA) and single antiemetic prophylaxis of 5-hydroxytryptamine type 3 (5 HT3)-receptor antagonist after the general anesthesia.Materials and MethodsIn this retrospective study, incidence and risk factors for PONV were evaluated with fentanyl IV-PCA during postoperative 48 hours after various surgeries.ResultsFour hundred-forty patients (23%) of 1878 had showed PONV. PCA was discontinued temporarily in 268 patients (14%), mostly due to PONV (88% of 268 patients). In multivariate analysis, female, non-smoker, history of motion sickness or PONV, long duration of anesthesia (>180 min), use of desflurane and intraoperative remifentanil infusion were independent risk factors for PONV. If one, two, three, four, five, or six of these risk factors were present, the incidences of PONV were 18%, 19%, 22%, 31%, 42%, or 50%. Laparoscopic surgery and higher dose of fentanyl were not risk factors for PONV.ConclusionDespite antiemetic prophylaxis with 5 HT3-receptor antagonist, 23% of patients with fentanyl-based IV-PCA after general anesthesia showed PONV. Long duration of anesthesia and use of desflurane were identified as risk factors, in addition to risk factors of Apfel's score (female, non-smoker, history of motion sickness or PONV). Also, intraoperative remifentanil infusion was risk factor independent of postoperative opioid use. As the incidence of PONV was up to 50% according to the number of risk factors, risk-adapted, multimodal or combination therapy should be applied.

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Section: Discussionsupporting

confidence: 77%

Incidence and Risk Factors of Postoperative Nausea and Vomiting in Patients with Fentanyl-Based Intravenous Patient-Controlled Analgesia and Single Antiemetic Prophylaxis

et al. 2014

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“…However, the usefulness of response entropy for the detection of impending arousal or its relation to surgical stimulation has not yet been determined. Comparing drug consumption in our study with that in other published reports using propofol-remifentanil infusion [3,16], we note that in our study the remifentanil infusion in both groups was nearly doubled, whereas the propofol dose was comparable.…”

Section: Discussionsupporting

confidence: 68%

M‐Entropy guidance vs standard practice during propofol‐remifentanil anaesthesia: a randomised controlled trial*

et al. 2007

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SummarySeventy-two patients undergoing routine surgical procedures under propofol-remifentanil anaesthesia were randomly assigned to receive either standard clinical practice (n = 35) or standard practice plus monitoring of depth of anaesthesia with M-Entropy (n = 37). Patients in the standard practice group received more propofol than the entropy group (mean (SD) 95 (14) vs 81 (22) lg.kg )1 .min )1 , respectively; p < 0.01), and less remifentanil (0.39 (0.08) vs 0.46 (0.08) lg.kg )1 .min )1 , respectively; p < 0.001). Loss of consciousness was best predicted by BIS (prediction probability (P K ) 0.96) and response entropy (P K 0.93), whereas emergence was best predicted by response entropy (P K 0.94).

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“…A total of 13 trials reported pain intensity at or around 2 h postsurgery, in which 686 patients received anaesthesia using propofol for maintenance, while 668 were given inhalational anaesthesia [10,11,[18][19][20][21][22][23][24][25][26][27][28]. Overall, pain scores were not significantly different between experimental groups (Hedge's g (95%CI) À0.120 (À0.415-0.175) (p = 0.425) (Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Eight studies investigated postoperative nausea and vomiting, with 371 patients receiving propofol and 354 patients receiving inhalational anaesthesia [10,19,20,22,24,25,28,30]. Propofol was associated with a significant reduction in postoperative nausea and vomiting (relative risk (95% CI) 0.446 (0.304-0.656) (p < 0.0001) (Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Postoperative nausea and vomiting is a common and distressing complication of anaesthesia, with a recently reported incidence of around 30% for [22] 4 (26) 5 9260 0.800 Hocker et al [24] 10 (51) 13 (52) 0.784 Hofer et al [25] 84 (155) 125 (146) 0.633 vomiting and around 50% for nausea [38]. It is also associated with prolonged recovery stay and unexpected hospital admission with subsequent higher health care costs [42].…”

Section: Discussionmentioning

confidence: 99%

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Effects of intra‐operative maintenance of general anaesthesia with propofol on postoperative pain outcomes – a systematic review and meta‐analysis

et al. 2016

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SummaryPropofol is used both for induction and maintenance of anaesthesia. Recent evidence shows that propofol has analgesic properties. This meta-analysis evaluated differences in postoperative analgesia between general anaesthetic maintenance with intravenous propofol and inhalational anaesthetics. Fourteen trials met inclusion criteria and were included. Our outcomes were pain scores 2 and 24 h after surgery. No significant difference in pain scores was found at 2 h after surgery (Hedge's g (95% CI) À0.120 (À0.415-0.175) (p = 0.425). Propofol was associated with a statistically significant, albeit marginal, reduction in pain scores 24 h after surgery (Hedge's g (95% CI) À0.134 (À0.248 to À0.021) (p = 0.021). Data were insufficient to allow a meaningful analysis regarding 24-h morphine-equivalent consumption. Propofol was associated with reduced postoperative nausea and vomiting (relative risk (95%CI) 0.446 (0.304-0.656) (p < 0.0001). In conclusion, this meta-analysis suggests that propofol improves postoperative analgesia compared with inhalational anaesthesia 24 h after surgery, with a lower incidence of nausea and vomiting.

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Propofol/remifentanil vs sevoflurane/remifentanil for long lasting surgical procedures: a randomised controlled trial

Cited by 24 publications

References 27 publications

Incidence and Risk Factors of Postoperative Nausea and Vomiting in Patients with Fentanyl-Based Intravenous Patient-Controlled Analgesia and Single Antiemetic Prophylaxis

Incidence and Risk Factors of Postoperative Nausea and Vomiting in Patients with Fentanyl-Based Intravenous Patient-Controlled Analgesia and Single Antiemetic Prophylaxis

M‐Entropy guidance vs standard practice during propofol‐remifentanil anaesthesia: a randomised controlled trial*

Effects of intra‐operative maintenance of general anaesthesia with propofol on postoperative pain outcomes – a systematic review and meta‐analysis

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