(S-19) Tang, J., Saturday 9:15
TITLE: ANTIEMETIC PROPHYLAXIS WITH SEVOFLURANE ANESTHESIA: A COMPARISON WITH PROPOFOL IN THE OFFICE SETTING
AUTHORS: Jun Tang1, MD, P.F. White1, PhD, MD, M.S. Karlan1, MD, R.Y. Uyeda1, MD, R. Kariger2, MD, R.H. Wender2, MD
AFFILIATION: 1Cedars-Sinai Medical Center, Los Angeles, CA; 2Bedford Surgical Center, Beverly Hills, CA.
INTRODUCTION: As a result of its cost-saving advantages, the volume of office-based surgery is rapidly increasing. Postoperative nausea and vomiting (PONV) after sevoflurane anesthesia has been found to delay discharge compared to propofol in the office-based setting1. We hypothesized that the recovery profiles would be comparable for propofol and sevoflurane-based anesthetic techniques with effective anti- emetic prophylaxis.
METHODS: Following IRB-approval, 106 ASA I-III con- senting outpatients undergoing superficial surgical procedures lasting 20-40 min were randomly assigned to one of three general anesthetic groups. Propofol was administered to induce anesthesia for all patients, followed by either propofol, 100 µg•kg-1•min-1 iv, in combination with N2O 67% in oxygen (Group I), or sevoflurane 1% with N2O 67% in oxygen (Groups II and III). The titration of propofol or sevoflurane was adjusted to achieve a clinically adequate depth of anesthesia with EEG bispectral index values of 50-70. For antiemetic prophylaxis, either propofol 25 mg (Group II), or a combination of antiemetic therapy (droperidol 0.625 mg, metoclopramide 10 mg and ondansetron 4 mg in Group III) was administered at the end of surgery. All patients received local anesthesia at the incisional site to minimize postoperative pain. Times to eye opening, following commands and orientation were noted by a blinded observer. "Home readiness" was determined using criteria for fast-tracking outpatients after ambulatory surgery2. In addition, the times to tolerating oral fluid, ambulating, and actual discharge home and the incidence of PONV were recorded. Data were analyzed using one-way ANOVA, and Chi-square test, with a p- value <0.05 considered significant (a p<0.05 vs. Group II).
RESULTS: The three anesthetic groups were comparable with respect to demographic characteristics and amount of local anesthetics injected. Although the early recovery variables were similar in all three groups, the times to recovery room stay and actual discharge were significantly prolonged in Group II. As expected, the incidence of PONV was also significantly higher in Group II.
|
Group |
I |
II |
III |
|
Age (yr) |
57±18 |
50±17 |
48±15 |
|
Weight (lb) |
147±31 |
141±35 |
140±37 |
|
Anesthesia time (min) |
36±14 |
40±18 |
38±21 |
|
Propofol dosage (mg) |
319±98 |
147±81 |
136±30 |
|
End-tidal sevoflurane (%) |
0.9±0.3 |
1.0±0.3 |
|
|
Eye opening (min) |
6±2 |
6±3 |
6±2 |
|
Following commands (min) |
6±2 |
6±3 |
6±2 |
|
Orientation (min) |
6±3 |
6±3 |
7±3 |
|
Sitting up (min) |
14±4 |
19±19 |
14±7 |
|
Standing up (min) |
21±12 |
20±12 |
16±9 |
|
Ambulates (min) |
23±15 |
22±17 |
16±9 |
|
Tolerate fluids (min) |
22±7a |
30±21 |
25±9 |
|
"Fit" for discharge (min) |
21±10 |
25±21 |
23±11 |
|
Recovery room stay (min) |
37±13a |
47±19 |
37±12a |
|
Actual discharge (min) |
51±14a |
62±20 |
53±15a |
|
PONV prior to discharge (%) |
|||
|
Nausea |
3a |
18 |
5a |
|
vomiting |
0a |
15 |
3a |
|
rescue |
0a |
15 |
3a |
DISCUSSION: The increased incidence of PONV after sevo- flurane anesthesia was effectively attenuated by a combination of low-dose droperidol, metoclopramide, and ondansetron. Sevo- flurane with triple antiemetic prophylaxis is an effective alternative to propofol for office-based anesthesia with respect to facilitating earlier discharge.
REFERENCES:
1) Anesthesiology 1999; 91:253-61.
2) J Clin Anesth 1999;11:78-9.