Subhypnotic propofol infusion plus dexamethasone is more effective than dexamethasone alone for the prevention of vomiting in children after tonsillectomy

Erdem, Alı Fuat; Yörük, Özgür; Alici, Hacı Ahmet; Cesur, Mehmet; Atalay, Canan; Altaş, Enver; Kürşad, Hüsnü; Yüksek, Mustafa Şahin

doi:10.1111/j.1460-9592.2008.02675.x

Cited by 31 publications

(24 citation statements)

References 30 publications

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“…Several studies have demonstrated that propofol has antiemetic properties, including when administered in the subhypnotic dose range [128]. Low dose intraoperative propofol infusion (bolus of 1 mg/kg followed by an infusion of 20 µg kg −1 min −1 ), has been shown to reduce PONV when used by itself or when combined with other antiemetics [129, 130]. Also, small doses of propofol used as rescue therapy (20mg as needed) has been found to be as effective as ondansetron [131].…”

Section: ) Other Advantages Of Propofol Tivamentioning

confidence: 99%

Propofol: A Review of its Role in Pediatric Anesthesia and Sedation

2015

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Propofol is an intravenous agent used commonly for induction and maintenance of anesthesia, procedural and critical care sedation in children. The mechanisms of action on the central nervous system involve interactions at various neurotransmitter receptors, especially gamma-aminobutyric acid A receptor. Approved for use in the United States by the Federal Drugs and Administration (FDA) in 1989, its use for induction of anesthesia in children less than 3 years of age still remains off-label. Despite its wide use in pediatric anesthesia, there is conflicting literature about its safety and serious adverse effects in particular subsets of children. Particularly as children are not “little adults”, in this review, we emphasize the maturational aspects of propofol pharmacokinetics. Despite the myriad of propofol pharmacokinetic-pharmacodynamic studies and the ability to use allometrical scaling to smooth out differences due to size and age, there is no optimal model that can be used in target controlled infusion pumps for providing closed loop total intravenous anesthesia in children. As the commercial formulation of propofol is a nutrient-rich emulsion, the risk for bacterial contamination exist despite the FDA mandating addition of antimicrobial preservative, calling for manufacturers’ directions to discard open vials after six hours. While propofol has advantages over inhalation anesthesia like less postoperative nausea and emergence delirium in children, pain on injection remains a problem even with newer formulations. Propofol is known to depress mitochondrial function by its action as an uncoupling agent in oxidative phosphorylation. This has implications for children with mitochondrial diseases and the occurrence of propofol-related infusion syndrome, a rare but seriously life-threatening complication of propofol. At the time of this review, there is no direct evidence in humans for propofol induced neurotoxicity to the infant brain; however, current concerns of neuroapoptosis in developing brains induced by propofol persist and continue to be a focus of research.

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Section: ) Other Advantages Of Propofol Tivamentioning

confidence: 99%

Propofol: A Review of its Role in Pediatric Anesthesia and Sedation

2015

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“…Administration of steroids to patients undergoing tonsillectomy or adenoidectomy has been found to reduce postsurgical nausea, vomiting and pain, although it may also increase postsurgical bleeding [9,11]. Similarly, the ability of short acting intravenous anesthetics plus steroids to prevent postsurgical nausea and vomiting has been assessed in children undergoing tonsillectomy or adenoidectomy [4], but less is known about the association between anesthetic agents and bleeding after tonsillectomy. A meta-analysis showed that the concentrations of coagulation factors prior to surgery did not predict postsurgical bleeding [2].…”

Section: Discussionmentioning

confidence: 98%

“…To minimize postsurgical complications, most tonsillectomies are performed with the patient under general anesthesia and in a supine position [4]. While some patients undergo tonsillectomy alone, others also undergo other types of surgery at the same time.…”

Section: Introductionmentioning

confidence: 99%

Analysis of prognostic factors for postoperative bleeding after tonsillectomy

Kim

Lee

Kim

et al. 2011

Eur Arch Otorhinolaryngol

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Postoperative bleeding is the most frequent surgical complication after tonsillectomy and may be associated with increased mortality rate. We have, therefore, analyzed factors associated with and prognostic for bleeding after tonsillectomy. The 2,254 patients who underwent tonsillectomy under general anesthesia at our institution from January 2005 to December 2009 were divided into bleeding and non-bleeding groups, and their demographic and clinical characteristics were compared. Age, administration of steroid immediately after general anesthesia, absence of administration of non-steroidal anti-inflammatory drugs, and the surgeon's experience were significantly associated with bleeding. In contrast, gender, chief complaints, performance of associated surgery, and type of anesthetic were not associated with postoperative bleeding. Hemorrhage after tonsillectomy was associated with the administration of steroids and with the non-administration of non-steroidal anti-inflammatory drugs.

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“…However, pain on injection of propofol may be uncomfortable to an awakening patient. Erdem et al [5] reported that intraoperative infusion of 20 µg/kg/min of propofol had a prophylactic antiemetic effect. Another study showed that 1.0 mg/kg of propofol at the end of surgery reduced both PONV and emergence agitation in children [6].…”

Section: Discussionmentioning

confidence: 99%

“…Propofol has been reported to be an effective antiemetic at low doses in patients undergoing anticancer therapy [3] and surgery [4,5,6] in many articles, but the precise mechanism by which propofol works as an antiemetic is unclear [2]. In this study, we evaluated the preventive antiemetic efficacy of different doses of propofol administered 15 minutes before the end of surgery without delaying emergence in middle aged females undergoing laparoscopic gynecologic surgery and receiving opioid-based intravenous patient controlled analgesia (PCA).…”

Section: Introductionmentioning

confidence: 99%

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

Kim

Park

et al. 2014

Korean J Anesthesiol

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BackgroundPostoperative nausea and vomiting (PONV) commonly occur after general anesthesia, especially in women. In this study, we evaluated the antiemetic efficacy of propofol administered at the end of surgery in highly susceptible patients undergoing a laparoscopy-assisted vaginal hysterectomy.MethodsA total of 107 women undergoing a laparoscopy-assisted vaginal hysterectomy under general anesthesia were enrolled for this prospective, double-blind, randomized study. Fifteen minutes before the end of surgery, all patients received 50 µg fentanyl and 1 of following 3 doses; 0.5 mg/kg of propofol (propofol 0.5 group), 1 mg/kg of propofol (propofol 1.0 group), and normal saline (control group). All patients received intravenous patient-controlled analgesia (PCA). Emergence time, a visual analog scale for pain and nausea, duration of postanesthesia care unit (PACU) stay, and frequency of antiemetic use were recorded at 0-2, 2-24, and 24-48 hours postoperatively.ResultsThe incidence of nausea significantly lower in the propofol 0.5 and propofol 1.0 groups than in the control group (12.1 vs 14.7 vs 40%). During the first postoperative 2 hours, antiemetics were less frequently administered in the propofol 0.5 and propofol 1.0 groups than in the control group (3.0 vs 5.9 vs 22.5%). Emergence time was slightly longer in the propofol 0.5 and propofol 1.0 groups than in the control group, but there was no significant difference in PACU stay time was observed between the 3 groups.ConclusionsThe results of this study suggest that low-dose propofol administration at the end of surgery may effectively reduce the incidence of PONV within 2 hours postoperatively in highly susceptible women undergoing a laparoscopiy-assisted vaginal hysterectomy and receiving opioid-based PCA.

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Subhypnotic propofol infusion plus dexamethasone is more effective than dexamethasone alone for the prevention of vomiting in children after tonsillectomy

Abstract: For children undergoing tonsillectomy, intraoperative subhypnotic propofol infusion combined with dexamethasone treatment provides a better prophylaxis against postoperative vomiting than does dexamethasone alone.

Cited by 31 publications

References 30 publications

Propofol: A Review of its Role in Pediatric Anesthesia and Sedation

Propofol: A Review of its Role in Pediatric Anesthesia and Sedation

Analysis of prognostic factors for postoperative bleeding after tonsillectomy

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

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