Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2014.07.005
Brazilian Journal of Anesthesiology
Scientific Article

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

Efeitos de um novo método de anestesia combinando propofol e anestesia volátil sobre a incidência de náusea e vômito no pós-operatório em pacientes submetidas à laparoscopia ginecológica

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

http://dx.doi.org/10.1016/j.bjane.2014.07.005 Braz J Anesthesiol, vol.66, n1, p.12-18, 2016
PDF English
PDF Português
Downloads: 2
Views: 694

Abstract

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)".

Keywords

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

Resumo

JUSTIFICATIVA: Investigamos os efeitos de um novo método de anestesia, que combina propofol e anestesia volátil, sobre a incidência de náusea e vômito no período pós-operatório de pacientes submetidas à laparoscopia ginecológica. MÉTODOS: As pacientes foram randomicamente divididas em três grupos: manutenção com sevoflurano (Grupo S, n = 42), com propofol (Grupo P, n = 42) ou com a combinação de propofol e sevoflurano (Grupo PS, n = 42). Avaliamos as respostas completas (sem náusea e vômito no pós-operatório e sem uso de antiemético de resgate), incidência de náusea e vômito, escore de gravidade da náusea, frequência de vômitos, uso de antiemético de resgate e dor no pós-operatório em duas e 24 horas após a cirurgia. RESULTADOS: O número de doentes que apresentou uma resposta completa foi maior nos grupos P e PS do que no Grupo S em 0-duas horas (74%, 76% e 43%m respectivamente, p = 0,001) e 0-24 horas (71%, 76% e 38%, respectivamente, p < 0,0005). A incidência de náusea em 0-duas horas (Grupo S = 57%, Grupo P = 26% e Grupo PS = 21%, p = 0,001) e 0-24 horas (Grupo S = 62%; Grupo P = 29% e grupo PS = 21%, p < 0,0005) também foi significativamente diferente entre os grupos. Porém, não houve diferença significativa entre os grupos em relação à incidência ou frequência de vômitos ou uso de antiemético de resgate em 0-24 horas. CONCLUSÃO: A combinação de propofol e anestesia volátil durante a laparoscopia ginecológica efetivamente diminui a incidência de náusea no pós-operatório.

Palavras-chave

Náusea e vômito pós-operatórios, Propofol, Sevoflurano, Anestesia geral, Laparoscopia

References

Tanaka K, Weihrauch D, Ludwig LM. Mitochondrial adenosine triphosphate-regulated potassium channel opening acts as a trigger for isoflurane-induced preconditioning by generating reactive oxygen species. Anesthesiology.. 2003;98:935-43.

Tanaka K, Ludwig LM, Kersten JR. Mechanisms of cardioprotection by volatile anesthetics. Anesthesiology.. 2004;100:707-21.

Crystal GJ, Gurevicius J, Salem MR. Role of adenosine triphosphate-sensitive potassium channels in coronary vasodi- lation by halothane, isoflurane, and enflurane. Anesthesiology.. 1997;86:448-58.

Zhou X, Abboud W, Manabat NC. Isoflurane-induced dila- tion of porcine coronary arterioles is mediated by ATP-sensitive potassium channels. Anesthesiology.. 1998;89:182-9.

Habib AS, White WD, Eubanks S. A randomized compari- son of a multimodal management strategy versus combination antiemetics for the prevention of postoperative nausea and vomiting. Anesth Analg.. 2004;99:77-81.

Mukherjee K, Seavell C, Rawlings E. A comparison of total intravenous with balanced anaesthesia for middle ear surgery: effects on postoperative nausea and vomiting, pain, and condi- tions of surgery. Anaesthesia.. 2003;58:176-80.

Pinaud M, Lelausque JN, Chetanneau A. Effects of propo- fol on cerebral hemodynamics and metabolism in patients with brain trauma. Anesthesiology.. 1990;73:404-9.

Cheng SS, Yeh J, Flood P. Anesthesia matters: patients anes- thetized with propofol have less postoperative pain than those anesthetized with isoflurane. Anesth Analg.. 2008;106:264.

Marana E, Colicci S, Meo F. Neuroendocrine stress response in gynecological laparoscopy: TIVA with propofol versus sevoflu- rane anesthesia. J Clin Anesth.. 2010;22:250-5.

Boehler M, Mitterschiffthaler G, Schlager A. Korean hand acu- pressure reduces postoperative nausea and vomiting after gyne- cological laparoscopic surgery. Anesth Analg.. 2002;94:872.

Fleisher LA, Beckman JA, Brown KA. ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guide- lines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery): developed in collaboration with the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiolo- gists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vas- cular Surgery. Circulation.. 2007;116:e418-99.

Ghoneim MM. Awareness during anesthesia. Anesthesiology.. 2000;92:597-602.

Pabelick CM, Prakash YS, Kannan MS. Effects of halothane on sarcoplasmic reticulum calcium release channels in porcine airway smooth muscle cells. Anesthesiology.. 2001;95:207-15.

Ishibe Y, Gui X, Uno H. Effect of sevoflurane on hypoxic pulmonary vasoconstriction in the perfused rabbit lung. Anes- thesiology.. 1993;79:1348-53.

Schwarzkopf K, Schreiber T, Preussler NP. Lung perfusion, shunt fraction, and oxygenation during one-lung ventilation in pigs: the effects of desflurane, isoflurane, and propofol. J Car- diothorac Vasc Anesth.. 2003;17:73-5.

Migita T, Mukaida K, Hamada H. Effects of propofol on cal- cium homeostasis in human skeletal muscle. Anaesth Intensive Care.. 2009;37:415-25.

Sumitani M, Uchida K, Yasunaga H. Prevalence of malig- nant hyperthermia and relationship with anesthetics in Japan: data from the diagnosis procedure combination database. Anes- thesiology.. 2011;114:84-90.

Nakahata K, Kinoshita H, Azma T. Propofol restores brain microvascular function impaired by high glucose via the decrease in oxidative stress. Anesthesiology.. 2008;108:269-75.

Murphy PG, Myers DS, Davies MJ. The antioxidant potential of propofol (2,6-diisopropylphenol). Br J Anaesth.. 1992;68:613-8.

Eriksson H, Korttila K. Recovery profile after desflurane with or without ondansetron compared with propofol in patients undergoing outpatient gynecological laparoscopy. Anesth Analg.. 1996;82:533-8.

Apfel CC, Kranke P, Katz MH. 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;88:659-68.

Borgeat A, Wilder-Smith OH, Saiah M. Subhypnotic doses of propofol possess direct antiemetic properties. Anesth Analg.. 1992;74:539-41.

Gan TJ, Ginsberg B, Grant AP. Double-blind, random- ized comparison of ondansetron and intraoperative propofol to prevent postoperative nausea and vomiting. Anesthesiology.. 1996;85:1036-42.

DiFlorio T. Is propofol a dopamine antagonist?. Anesth Analg.. 1993;77:200-1.

Gan TJ, Glass PS, Howell ST. Determination of plasma concentrations of propofol associated with 50% reduction in postoperative nausea. Anesthesiology.. 1997;87:779-84.

Gan TJ, Meyer T, Apfel CC. Consensus guidelines for managing postoperative nausea and vomiting. Anesth Analg.. 2003;97:62.

Tramer MR. A rational approach to the control of post- operative nausea and vomiting: evidence from systematic reviews. Part I. Efficacy and harm of antiemetic interventions, and methodological issues. Acta Anaesthesiol Scand.. 2001;45:4-13.

Tramer MR. A rational approach to the control of post- operative nausea and vomiting: evidence from systematic reviews. Part II. Recommendations for prevention and treat- ment, and research agenda. Acta Anaesthesiol Scand.. 2001;45:14-9.

Scholz J, Steinfath M, Tonner PH. Postoperative nausea and vomiting. Curr Opin Anaesthesiol.. 1999;12:657-61.

Allan BT, Smith I. Cost considerations in the use of anaesthetic drugs. Curr Opin Anaesthesiol.. 2002;15:227-32.

5dcd99da0e8825cf52bf58f1 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections