Randomized Controlled Trial of Total Intravenous Anesthesia with Propofol versus  Inhalation Anesthesia with Isoflurane–Nitrous Oxide

Background To assess the incidence of postoperative nausea and vomiting after total intravenous anesthesia (TIVA) with propofol versus inhalational anesthesia with isoflurane-nitrous oxide, the authors performed a randomized trial in 2,010 unselected surgical patients in a Dutch academic institution. An economic evaluation was also performed. Methods Elective inpatients (1,447) and outpatients (563) were randomly assigned to inhalational anesthesia with isoflurane-nitrous oxide or TIVA with propofol-air. Cumulative incidence of postoperative nausea and vomiting was recorded for 72 h by blinded observers. Cost data of anesthetics, antiemetics, disposables, and equipment were collected. Cost differences caused by duration of postanesthesia care unit stay and hospitalization were analyzed. Results Total intravenous anesthesia reduced the absolute risk of postoperative nausea and vomiting up to 72 h by 15% among inpatients (from 61% to 46%, P < 0.001) and by 18% among outpatients (from 46% to 28%, P < 0.001). This effect was most pronounced in the early postoperative period. The cost of anesthesia was more than three times greater for propofol TIVA. Median duration of stay in the postanesthesia care unit was 135 min after isoflurane versus 115 min after TIVA for inpatients (P < 0.001) and 160 min after isoflurane versus 150 min after TIVA for outpatients (P = 0.039). Duration of hospitalization was equal in both arms. Conclusion Propofol TIVA results in a clinically relevant reduction of postoperative nausea and vomiting compared with isoflurane-nitrous oxide anesthesia (number needed to treat = 6). Both anesthetic techniques were otherwise similar. Anesthesia costs were more than three times greater for propofol TIVA, without economic gains from shorter stay in the postanesthesia care unit

Download Full-text

Postoperative Nausea and Vomiting and Postoperative Pain in Patients Undergoing Elective Laparoscopy; Comparison of Total Intravenous Anesthesia versus Inhalational Anesthesia; A Randomized Clinical Trial

Archives of Anesthesia and Critical Care ◽

10.18502/aacc.v6i2.2759 ◽

2020 ◽

Author(s):

Ali Ahmadzadeh Amiri ◽

Kasra Karvandian ◽

Mojgan Rahimi ◽

Mohammad Ashouri ◽

Amir Ahmadzadeh Amiri

Keyword(s):

Clinical Trial ◽

Postoperative Pain ◽

Postoperative Nausea ◽

Postoperative Nausea And Vomiting ◽

Postoperative Recovery ◽

Nausea And Vomiting ◽

Total Intravenous Anesthesia ◽

Inhalational Anesthesia ◽

Intravenous Anesthesia ◽

Significant Difference

Background: Two major complications of surgeries are postoperative nausea and vomiting (PONV) and also postoperative pain (POP). Several studies have compared total intravenous anesthesia (TIVA) with inhalational anesthesia regarding these two complications. Some results have shown a better postoperative recovery conditions, but other contradictory results can also be found. This study was performed to evaluate and compare the effect of inhalational and intravenous anesthesia in patients undergoing elective laparoscopic surgery, on the incidence and the severity of PONV and POP. Methods: This study was performed as a single-blinded prospective clinical trial. All patients aged 18-65, with ASA class I and II who underwent elective laparoscopy were included. Patients were divided into two groups of intravenous anesthesia and inhalational anesthesia. The incidence and the severity of PONV and POP were examined in 5 separated times after the surgery. The use of a rescue antiemetic and analgesic medication were also evaluated. Results: Overall, 67 patients received inhalational anesthesia and 55 patients received intravenous anesthesia. It was revealed that 47.8% of the patients in the inhalation group and 18.2% of the patients in the intravenous group developed PONV (P<0.001). The severity of PONV was significantly lower in the TIVA group (P<0.001), however, no statistically significant difference was found regarding the severity of abdominal pain (P=0.62). Conclusion: The incidence of PONV and the need for administration of an antiemetic rescue drug are significantly lower in the TIVA group.

Download Full-text

Postoperative Nausea and Vomiting in Day Care Patients: A Comparative Randomized Controlled Trial of Total Intravenous Anesthesia with Propofol, Air, and Oxygen vs Inhalation Anesthesia with Isoflurane and Nitrous Oxide

The Journal of Medical Sciences ◽

10.5005/jp-journals-10045-0019 ◽

2015 ◽

Vol 1 (4) ◽

pp. 63-68

Author(s):

A Sandhya ◽

R Mamatha ◽

Antara Banerjee

Keyword(s):

Nitrous Oxide ◽

Postoperative Nausea ◽

Day Care ◽

Controlled Trial ◽

Postoperative Nausea And Vomiting ◽

Nausea And Vomiting ◽

Total Intravenous Anesthesia ◽

Intravenous Anesthesia ◽

Group I ◽

Group Ii

ABSTRACT Introduction We compared the incidence of postoperative nausea and vomiting (PONV) after total intravenous anesthesia (TIVA) using propofol–air to inhalational anesthesia with isoflurane–nitrous oxide in day care patients at a tertiary care academic institution. Materials and methods We randomized 60 patients and assigned to either group I (inhalational anesthesia with isoflurane– nitrous oxide) or group II (TIVA with propofol–air). Incidence of PONV, use of anti-emetics, and duration of stay in the recovery were recorded for 72 hours by blinded observers. Results Total intravenous anesthesia reduced the PONV up to 72 hours by 27% among our patients (from 37 to 10%, p < 0.001). This effect was seen more in the early postoperative period. Overall, 13.3% of patients in the group I received antiemetic compared to 40% in group II. In our study, patients without PONV were discharged from the recovery room 15 minutes earlier after TIVA than after isoflurane and N2O anesthesia. Conclusion Total intravenous anesthesia with propofol and air resulted in a reduction of PONV compared with iso-flurane–nitrous oxide anesthesia. Overall, patients in group I required less rescue antiemetic, compared to group II. Total intravenous anesthesia resulted in shorter stay in the postoperative anesthetic care unit compared to isoflurane–N2O group. How to cite this article Sandhya A, Mamatha R, Banerjee A, Sahajananda H. Postoperative Nausea and Vomiting in Day Care Patients: A Comparative Randomized Controlled Trial of Total Intravenous Anesthesia with Propofol, Air, and Oxygen vs Inhalation Anesthesia with Isoflurane and Nitrous Oxide. J Med Sci 2015;1(4):63-68.

Download Full-text