Abstracts of Posters Presented at the International Anesthesia Research Society; 72nd Clinical and Scientific Congress; Orlando, FL; March 7-11, 1998: Ambulatory Anesthesia
Introduction: Controversy exists regarding the choice of prophylactic antiemetics in outpatients undergoing laparoscopic procedures with an inhalation-based anesthetic technique . Therefore, a prospective, randomized, placebo-controlled, single-blind study was designed to compare the antiemetic effectiveness of a subhypnotic dose of propofol (0.5 mg/kg iv) and low-dose of droperidol (0.625 mg iv) when administered at the end of surgery under desflurane anesthesia.
Methods: Ninety-six healthy consenting females undergoing laparoscopic cholecystectomy were assigned to one of three study groups. Anesthesia was induced with midazolam, 2 mg iv, fentanyl, 100 [micro sign]g iv, propofol, 2 mg/kg iv, and rocuronium, 0.6 mg/kg iv, and was maintained with desflurane 3-8% in combination with nitrous oxide 65% in oxygen. Supplemental fentanyl, 50 [micro sign]g iv boluses, were administered for persistent hypertension (MAP>30% of baseline value) or tachycardia (HR >100 bpm). Muscle relaxation was maintained with rocuronium, 0.15 mg/kg iv boluses. At skin closure, one of three study drugs was administered: (1) saline 5 ml iv, (2) propofol, 0.5 mg/kg iv, or (3) droperidol 0.625 mg iv. The times from discontinuation of desflurane/N2 O to awakening, orientation and home-readiness were recorded. The incidences of postoperative nausea and vomiting (PONV) and requests for antiemetic rescue medication were evaluated during the first 24 hours after surgery. Data were analyzed using ANOVA for continuous variables and Chi-square test for discrete variables, with p-values <0.05 considered statistically significant.
Results: There were no differences among the groups with respect to demographic characteristics or the need for adjunctive drugs. The early recovery times were 30-40% longer in the propofol group compared to the saline and droperidol groups (Table 1). The droperidol group had the lowest incidence of PONV and the shortest time to home-readiness (Table 1).
Conclusions: Low-dose droperidol (0.625 mg) given at the end of surgery is an effective prophylactic antiemetic after desflurane anesthesia and can contribute to an earlier discharge home after laparoscopic cholecystectomy. Administration of a subhypnotic dose of propofol (0.5 mg/kg) delayed emergence from desflurane anesthesia without reducing emetic symptoms in the postoperative period.
1. Anesth Analg 1996; 83: 304-13.