Small dose of propofol combined with dexamethasone for postoperative vomiting in pediatric Moyamoya disease patients: a prospective, observer-blinded, randomized controlled study

Abstract

BackgroundFor effective postoperative antiemetic management in pediatric moyamoya disease patients receiving fentanyl based postoperative analgesia, a multimodal approach has been recommended. The uncertain efficacy of ondansetron for pediatric neurosurgical patients or the possible antiemetic effect of small dose of propofol motivated us to evaluate the preventive effect of a subhypnotic dose of propofol combined with dexamethasone on postoperative vomiting (POV), especially during immediate postoperative periods.MethodsIn a prospective observer-blind randomized controlled study, we compared dexamethasone 0.15 mg/kg alone (Group D) with dexamethasone combined with propofol of 0.5 mg/kg (Group DP) in 60 pediatric patients, aged 4-17 years, who underwent indirect bypass surgery and received fentanyl-based postoperative analgesia. Occurrence of vomiting and pain score (Wong-Baker facial score) and requirement of rescue analgesic and antiemetic were continually measured (0-2, 2-6, 6-12 and 12-24 postoperative hours). For statistical analysis, in addition to the Fisher's exact test, a generalized linear mixed model (GLMM) and the linear mixed model (LMM) for repeated measures were used for vomiting and pain scores, respectively.ResultsThere was no statistical significance of POV incidence, requirement of rescue analgesic and pain score between the two groups at any measured intervals. The incidence of POV was 53.3% during 24 hours in both groups, and was especially 6.7% and 13.3% (P = 0.671) during 0-2 hr and 16.7% and 23.3% (P = 0.748) during 2-6 hr in group D and group DP, respectively.ConclusionsA small dose of propofol combined with dexamethasone appears ineffective to preventing POV in pediatric moyamoya patients receiving continuous fentanyl infusion.

Antiemetic effect of propofol administered at the end of surgery in laparoscopic assisted vaginal hysterectomy

“…In contrast to the previous study [ 16 ], there was the prolongation of emergence time in the propofol 0.5 and propofol 1.0 groups compared to the control group (P < 0.05). However, prolonged time was only 2.6-3.4 minutes, and it may not be significant in clinical practice.…”

“…Another study showed that 1.0 mg/kg of propofol at the end of surgery reduced both PONV and emergence agitation in children [ 6 ]. On the other hand, Kim et al [ 16 ] reported that 0.5 mg/kg of propofol combined with dexamethasone was not effective in the prevention of PONV in pediatric patients with moyamoya disease.…”

Assessment of P values for demographic data in randomized controlled trials

“…In a small study, the P value may not reach statistical significance, even when there is a clinically relevant difference in a given baseline characteristic. For example, as shown in Table 2 [6], patient ages are not statistically different (8.1 [3.4] versus 10.0 [3.9]; P = 0.052). However, an almost 2-year gap in a group of pediatric patients could have a meaningful effect on the result in a clinical situation.…”

“…Respectively, 31, 60, 67, 17, 31, and 35 of the 312 RCTs reported P values for comparisons of ASA, height, weight, BMI, duration of anesthesia and surgery. Eighty-three (26.5%) studies reported P values in baseline data tables, among which 6 [6–11] reported P values that were statistically significant (i.e., < 0.05). Descriptions such as “similar” or “comparable” in the article were not considered as significant.…”