Background and Goal of Study:The higher prevalence of postoperative nausea and vomiting (PONV) among patients for whom volatile anesthetics are used in maintenance of general anesthesia compared with those for whom total intravenous anesthesia (TIVA) is used is well known. This trend may be caused by the emetic effect of inhalational anesthesia and the antiemetic effect of propofol. The aim of this study was to evaluate the hypothesis that, when using propofol in combination with inhalational anesthesia, the incident rate of PONV would be reduced to the same level as with TIVA.

Materials and Methods:A prospective randomized controlled trial was conducted with 72 patients aged 20 to 65. They underwent laparoscopic surgery for benign gynecological disease from August 2016 through February 2017. This research was approved by the Ethics Committee and is registered in UMIN. Patients who provided written informed consent were randomly allocated to a TIVA group (group T, n=36) or sevoflurane/propofol group (group SP, n=36). After epidural anesthesia, general anesthesia was performed. For maintenance of anesthesia, group T received propofol and the bispectral index (BIS) was adjusted to around 40-60. For group SP, patients received anesthesia using 0.8% sevoflurane and propofol at a 1.2 g/ml target plasma concentration in a target-controlled infusion pump, respectively. We analyzed the PONV incidence rates in both groups. Comparisons were done using the chi-square test for categorical variables. The Mann-Whitney U test or t-test was used for numerical variables.

Results and Discussion:The demographic data showed no significant difference between the groups. There was no significant difference in the PONV incidence between groups T and SP (27.8% vs. 33.3%, p=0.691). Nor was there a significant difference between the total PONV scores of groups T and SP (median: 0, IQR: 0-1 vs. median: 0, IQR: 0-2, p=0.643) and whether an antiemetic drug was used (22.2% vs. 22.2%, p=1.000).

Conclusion:By adding propofol infusion to sevoflurane anesthesia, the incidence of PONV may be reduced to the same level as with TIVA.

02 / Comparison of the incidence rate of postoperative nausea and vomiting between sevoflurane anesthesia with continuous propofol infusion and total intravenous anesthesia in gynecological laparoscopic surgery