Effects of a novel method of anesthesia combining propofol and volatile anesthesia on the incidence of postoperative nausea and vomiting in patients undergoing laparoscopic gynecological surgery

Kawano, Hiroaki; Ohshita, Naohiro; Katome, Kimiko; Kadota, Takako; Kinoshita, Michiko; Matsuoka, Yayoi; Tsutsumi, Yasuo M.; Kawahito, Shinji; Tanaka, Katsuya; Oshita, Shuzo

doi:10.1016/j.bjane.2014.07.005

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Scientific Articles • Rev. Bras. Anestesiol. 66 (1) • Jan-Feb 2016 • https://doi.org/10.1016/j.bjane.2014.07.005 copy

Effects of a novel method of anesthesia combining propofol and volatile anesthesia on the incidence of postoperative nausea and vomiting in patients undergoing laparoscopic gynecological surgery^☆ ☆ Presented in part at the 57th Annual Meeting of the Japanese Society of Anesthesiologists, Fukuoka, Japan, 3-5 June 2010.

Authorship SCIMAGO INSTITUTIONS RANKINGS

BACKGROUND:

We investigated the effects of a novel method of anesthesia combining propofol and volatile anesthesia on the incidence of postoperative nausea and vomiting in patients undergoing laparoscopic gynecological surgery.

METHODS:

Patients were randomly divided into three groups: those maintained with sevoflurane (Group S, n = 42), propofol (Group P, n = 42), or combined propofol and sevoflurane (Group PS, n = 42). We assessed complete response (no postoperative nausea and vomiting and no rescue antiemetic use), incidence of nausea and vomiting, nausea severity score, vomiting frequency, rescue antiemetic use, and postoperative pain at 2 and 24 h after surgery.

RESULTS:

The number of patients who exhibited a complete response was greater in Groups P and PS than in Group S at 0-2 h (74%, 76% and 43%, respectively, p = 0.001) and 0-24 h (71%, 76% and 38%, respectively, p < 0.0005). The incidence of nausea at 0-2 h (Group S = 57%, Group P = 26% and Group PS = 21%, p = 0.001) and 0-24 h (Group S = 62%, Group P = 29% and Group PS = 21%, p < 0.0005) was also significantly different among groups. However, there were no significant differences among groups in the incidence or frequency of vomiting or rescue antiemetic use at 0-24 h.

CONCLUSION:

Combined propofol and volatile anesthesia during laparoscopic gynecological surgery effectively decreases the incidence of postoperative nausea. We term this novel method of anesthesia "combined intravenous-volatile anesthesia (CIVA)".

Postoperative nausea and vomiting; Propofol; Sevoflurane; General anesthesia; Laparoscopy

	Group S (n = 42)	Group P (n = 42)	Group PS (n = 42)
Age (years)	38.9 ± 13.0	37.5 ± 13.0	40.0 ± 13.3
Height (cm)	157.6 ± 5.0	156.4 ± 5.1	157.5 ± 5.9
Weight (kg)	53.8 ± 6.9	51.8 ± 8.2	53.6 ± 9.6
MABP at admittance (mmHg)	94.9 ± 15.5	97.8 ± 14.6	92.9 ± 14.2
ASA physical status (I/II)	30/12	31/11	30/12
Smoking (n)	6	4	8
History motion sickness and/or PONV (n)	17	14	15

Phase of menstrual cycle (n)
Follicular	17	16	17
Luteal	18	20	15
Postmenopause	7	6	10

	Group S (n = 42)	Group P (n = 42)	Group PS (n = 42)
Duration of anesthesia (min)	171.2 ± 58.6	167.9 ± 67.1	155.5 ± 48.7
Duration of surgery (min)	124.7 ± 54.5	122.1 ± 65.3	111.5 ± 48.7

Anesthetics
Remifentanil (mg)	3.082 ± 1.884	3.197 ± 1.856	3.055 ± 1.420
Rocuronium (mg)	54.8 ± 13.2	53.1 ± 13.4	50.6 ± 13.0

Type of surgery (n)
Ovarian cystectomy/tumorectomy	31	24	32
Adhesiolysis	2	5	2
Myomectomy	6	9	3
Salpingostomy	1	0	2
Ovarian drilling	1	0	1
Oophorectomy	1	4	2

Temperature (°C)	36.6 ± 0.4	36.4 ± 0.4	36.6 ± 0.6
Blood loss (mL)	28.8 ± 54.5	65.4 ± 142.7	31.4 ± 58.8
Fluid volume (mL)	1059.0 ± 312.3	1109.8 ± 440.9	1036.0 ± 341.1

	Group S (n = 42)	Group P (n = 42)	Group PS (n = 42)	p-Value
0–2 postoperative hours
Nausea	24 (57)	11 (26)^b	9 (21)^b	0.001^a
Significant nausea (moderate or severe)	16 (38)	7 (17)	3 (7)^b	0.001^a
Vomiting	4 (10)	5 (12)	3 (7)	0.759
Vomiting episodes in patients who vomited	2.3 ± 1.5	1.2 ± 0.4	2 ± 1.7	0.155
Postoperative nausea and/or vomiting	24 (57)	11 (26)^b	9 (21)^b	0.001^a
Rescue antiemetic	8 (19)	1 (2)	2 (5)	0.014^a
Complete response	18 (43)	31 (74)^b	33 (76)^b	0.001^a

2–24 postoperative hours
Nausea	11 (26)	5 (12)	4 (10)	0.078
Significant nausea (moderate or severe)	1 (2)	3 (7)	2 (5)	0.592
Vomiting	2 (5)	4 (10)	2 (5)	0.586
Vomiting episodes in patients who vomited	1.5 ± 0.7	2.3 ± 1.5	3 ± 0	0.530
Postoperative nausea and/or vomiting	11 (26)	5 (12)	4 (10)	0.078
Rescue antiemetic	2 (5)	3 (7)	0 (0)	0.233
Complete response	31 (74)	36 (86)	38 (90)	0.108

0–24 postoperative hours
Nausea	26 (62)	12 (29)^b	9 (21)^b	<0.0005^a
Significant nausea (moderate or severe)	17 (40)	8 (19)	4 (10)^b	0.003^a
Vomiting	4 (10)	6 (14)	3 (7)	0.549
Vomiting episodes in patients who vomited	3 ± 2.2	2.5 ± 1.2	4 ± 3	0.651
Postoperative nausea and/or vomiting	26 (62)	12 (29)^b	9 (21)^b	<0.0005^a
Rescue antiemetic	9 (21)	4 (10)	2 (5)	0.052
Complete response	16 (38)	30 (71)^b	33 (76)^b	<0.0005^a

	Group S (n = 42)	Group P (n = 42)	Group PS (n = 42)
Numerical rating scale (0–10)
Postoperative at
2 h	6.4 ± 2.5	5.6 ± 2.3	5.9 ± 3.0
24 h	4.1 ± 2.3	3.7 ± 1.9	3.8 ± 2.4

Postoperative diclofenac sodium (mg)	17.3 ± 18.7	16.7 ± 18.0	17.9 ± 18.5
Postoperative pentazocine (mg)	7.9 ± 8.9	8.6 ± 13.7	4.6 ± 7.4

Sociedade Brasileira de Anestesiologia R. Professor Alfredo Gomes, 36, 22251-080 Botafogo RJ Brasil, Tel: +55 21 2537-8100, Fax: +55 21 2537-8188 - Campinas - SP - Brazil
E-mail: bjan@sbahq.org

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[1] * Corresponding author. Present address: Department of Anesthesiology, Tokushima Prefectural Central Hospital, Tokushima, Japan. E-mail:hir.kawano@gmail.com (H. Kawano).