Yonsei Med J.  2012 Nov;53(6):1197-1202. 10.3349/ymj.2012.53.6.1197.

Total Intravenous Anesthesia with Propofol Reduces Postoperative Nausea and Vomiting in Patients Undergoing Robot-Assisted Laparoscopic Radical Prostatectomy: A Prospective Randomized Trial

• Yoo YC
• Bai SJ
• Lee KY
• Shin S
• Choi EK
• Lee JW

• KMID: 1414264
• DOI: http://doi.org/10.3349/ymj.2012.53.6.1197

Abstract

PURPOSE
We investigated the effect of total intravenous anesthesia (TIVA) with propofol on postoperative nausea and vomiting (PONV) after robot-assisted laparoscopic radical prostatectomy (RLRP) in patients at low risk of developing PONV, in comparison to balanced anesthesia with desflurane.
MATERIALS AND METHODS
Sixty two patients were randomly assigned to the Des or TIVA group. Propofol and remifentanil were used for induction of anesthesia in both groups and for maintenance of the anesthesia in the TIVA group. In the Des group, anesthesia was maintained with desflurane and remifentanil. In both groups, postoperative pain was controlled using fentanyl-based intravenous patient controlled analgesia, and ramosetron 0.3 mg was administered at the end of surgery. The incidence of PONV, severity of nausea and pain, and requirements of rescue antiemetics and analgesics were recorded.
RESULTS
The incidence of nausea in the post-anesthetic care unit was 22.6% in the Des group and 6.5% in the TIVA (p=0.001) group. The incidence of nausea at postoperative 1-6 hours was 54.8% in the Des group and 16.1% in the TIVA group (p=0.001). At postoperative 6-48 hours, there were no significant differences in the incidence of nausea between groups.
CONCLUSION
In order to prevent PONV after RLRP in the early postoperative period, anesthesia using TIVA with propofol is required regardless of patient-related risk factors.

Keyword

Postoperative nausea and vomiting; propofol; laparoscopic surgery; prostatectomy

MeSH Terms

Aged
Anesthesia, Intravenous/*methods
Humans
Laparoscopy/*methods
Male
Middle Aged
Postoperative Nausea and Vomiting/*prevention & control
Propofol/administration & dosage/*therapeutic use
Prostatectomy/*methods
Vomiting/*prevention & control

Figure

• 

  Fig. 1 The incidence of moderate to severe PONV during postoperative 48 hours. PONV, postoperative nausea and vomiting; patients with moderate to severe PONV, patients with VNRS ≥4 or with retching or vomiting at either time period; Des, patients receiving balanced anesthesia; TIVA, patients receiving total intravenous anesthesia; PACU, post anesthetic care unit; VNRS, verbal numerical rating scale. *p<0.05 vs. Des group.

Reference

1. Zorn KC, Gofrit ON, Orvieto MA, Mikhail AA, Zagaja GP, Shalhav AL. Robotic-assisted laparoscopic prostatectomy: functional and pathologic outcomes with interfascial nerve preservation. Eur Urol. 2007. 51:755–762.

2. Jung JH, Arkoncel FR, Lee JW, Oh CK, Yusoff NA, Kim KJ, et al. Initial clinical experience of simultaneous robot-assisted bilateral partial nephrectomy and radical prostatectomy. Yonsei Med J. 2012. 53:236–239.

3. Meininger D, Byhahn C, Bueck M, Binder J, Kramer W, Kessler P, et al. Effects of prolonged pneumoperitoneum on hemodynamics and acid-base balance during totally endoscopic robot-assisted radical prostatectomies. World J Surg. 2002. 26:1423–1427.

4. Iitomi T, Toriumi S, Kondo A, Akazawa T, Nakahara T. [Incidence of nausea and vomiting after cholecystectomy performed via laparotomy or laparoscopy]. Masui. 1995. 44:1627–1631.

5. Watcha MF, White PF. Postoperative nausea and vomiting. Its etiology, treatment, and prevention. Anesthesiology. 1992. 77:162–184.

6. Kovac AL. Prevention and treatment of postoperative nausea and vomiting. Drugs. 2000. 59:213–243.

7. Chen X, Tang J, White PF, Wender RH, Quon R, Sloninsky A, et al. The effect of timing of dolasetron administration on its efficacy as a prophylactic antiemetic in the ambulatory setting. Anesth Analg. 2001. 93:906–911.

8. Gold BS, Kitz DS, Lecky JH, Neuhaus JM. Unanticipated admission to the hospital following ambulatory surgery. JAMA. 1989. 262:3008–3010.

9. Apfel CC, Läärä E, Koivuranta M, Greim CA, Roewer N. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Anesthesiology. 1999. 91:693–700.

10. Lebenbom-Mansour MH, Pandit SK, Kothary SP, Randel GI, Levy L. Desflurane versus propofol anesthesia: a comparative analysis in outpatients. Anesth Analg. 1993. 76:936–941.

11. Gupta A, Stierer T, Zuckerman R, Sakima N, Parker SD, Fleisher LA. Comparison of recovery profile after ambulatory anesthesia with propofol, isoflurane, sevoflurane and desflurane: a systematic review. Anesth Analg. 2004. 98:632–641.

12. Fujii Y. Management of postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy. Surg Endosc. 2011. 25:691–695.

13. Habib AS, Gan TJ. Evidence-based management of postoperative nausea and vomiting: a review. Can J Anaesth. 2004. 51:326–341.

14. White PF, O'Hara JF, Roberson CR, Wender RH, Candiotti KA. POST-OP Study Group. The impact of current antiemetic practices on patient outcomes: a prospective study on high-risk patients. Anesth Analg. 2008. 107:452–458.

15. Apfel CC, Korttila K, Abdalla M, Kerger H, Turan A, Vedder I, et al. A factorial trial of six interventions for the prevention of postoperative nausea and vomiting. N Engl J Med. 2004. 350:2441–2451.

16. Marsh B, White M, Morton N, Kenny GN. Pharmacokinetic model driven infusion of propofol in children. Br J Anaesth. 1991. 67:41–48.

17. Minto CF, Schnider TW, Egan TD, Youngs E, Lemmens HJ, Gambus PL, et al. Influence of age and gender on the pharmacokinetics and pharmacodynamics of remifentanil. I. Model development. Anesthesiology. 1997. 86:10–23.

18. Fanelli G, Berti M, Casati A. Fast-track anaesthesia for laparoscopic cholecystectomy: a prospective, randomized, multicentre, blind comparison of desflurane-remifentanil or sevoflurane-remifentanil. Eur J Anaesthesiol. 2006. 23:861–868.

19. Khan JS, Hasan H, Iqbal M. Laparoscopic cholecystectomy; common bile duct injury after learning curve. Professional Med J. 2010. 17:373–378.

20. Barann M, Göthert M, Fink K, Bönisch H. Inhibition by anaesthetics of 14C-guanidinium flux through the voltage-gated sodium channel and the cation channel of the 5-HT3 receptor of N1E-115 neuroblastoma cells. Naunyn Schmiedebergs Arch Pharmacol. 1993. 347:125–132.

21. Vasileiou I, Xanthos T, Koudouna E, Perrea D, Klonaris C, Katsargyris A, et al. Propofol: a review of its non-anaesthetic effects. Eur J Pharmacol. 2009. 605:1–8.

22. Appadu BL, Strange PG, Lambert DG. Does propofol interact with D2 dopamine receptors? Anesth Analg. 1994. 79:1191–1192.

23. Sneyd JR, Carr A, Byrom WD, Bilski AJ. A meta-analysis of nausea and vomiting following maintenance of anaesthesia with propofol or inhalational agents. Eur J Anaesthesiol. 1998. 15:433–445.

24. Fredman B, Nathanson MH, Smith I, Wang J, Klein K, White PF. Sevoflurane for outpatient anesthesia: a comparison with propofol. Anesth Analg. 1995. 81:823–828.

25. Graham SG, Aitkenhead AR. A comparison between propofol and desflurane anaesthesia for minor gynaecological laparoscopic surgery. Anaesthesia. 1993. 48:471–475.

26. Tramèr M, Moore A, McQuay H. Propofol anaesthesia and postoperative nausea and vomiting: quantitative systematic review of randomized controlled studies. Br J Anaesth. 1997. 78:247–255.

27. Apfel CC, Kranke P, Katz MH, Goepfert C, Papenfuss T, Rauch S, et al. Volatile anaesthetics may be the main cause of early but not delayed postoperative vomiting: a randomized controlled trial of factorial design. Br J Anaesth. 2002. 88:659–668.

28. Naylor RJ, Inall FC. The physiology and pharmacology of postoperative nausea and vomiting. Anaesthesia. 1994. 49:Suppl. 2–5.

29. Gecaj-Gashi A, Hashimi M, Sada F, Baftiu N, Salihu S, Terziqi H, et al. Propofol vs isoflurane anesthesia-incidence of PONV in patients at maxillofacial surgery. Adv Med Sci. 2010. 55:308–312.

30. Grundmann U, Uth M, Eichner A, Wilhelm W, Larsen R. Total intravenous anaesthesia with propofol and remifentanil in paediatric patients: a comparison with a desflurane-nitrous oxide inhalation anaesthesia. Acta Anaesthesiol Scand. 1998. 42:845–850.