TITLE: TRIPLE ANTIEMETIC PROPHYLAXIS INVOLVING PROPOFOL, DROPERIDOL AND ONDANSETRON IS HIGHLY EFFECTIVE IN PREVENTING PONV

AUTHORS: Tong Joo Gan, Robert P. Hill, MB, FRCA, Eugene Moretti, MD, Diana Kucmeroski, BS, Theodore Pappas, MD, Steve Eubanks, MD
AFFILIATION: Duke University Medical Center, Durham, NC.

INTRODUCTION: Laparoscopic cholecystectomy is asso- ciated with a high incidence (65%) of postoperative nausea and vomiting (PONV). Combination antiemetics are more effective than individual antiemetic in preventing PONV. There is no published data comparing combination antiemetics in the presence of propofol based anesthetic. This study tests the hypothesis that propofol based anesthetic with combination antiemetic prophylaxis result in a lower incidence of PONV compared with inhalational anesthetic (isoflurane-N₂O-O₂) with similar antiemetic prophylaxis.
METHODS: With IRB approval and informed consent, adult ASA I and II patients scheduled for elective laparoscopic cholecystectomy were enrolled. Following premedication with midazolam and fentanyl, patients were administered a general anesthetic. Group 1: propofol induction and maintenance; droperidol 0.625mg at induction and ondansetron 4mg at skin closure (Prop-Combo); Group 2: propofol induction; maintenance with isoflurane/O₂; antiemetic regimen similar to Group 1 (Iso-Combo). Group 3: propofol induction and maintenance. N₂O was not used in all patients. Neuromuscular blockade was reversed in all patients with neostigmine and glycopyrrolate. Data on PONV, rescue antiemetic use and patient satisfaction were collected at 2 and 24 hours. Appropriate statistics were used. A p value <0.05 were considered significant.
RESULTS: There were 27, 25 and 26 patients in Groups 1, 2 and 3 respectively. Demographic data were similar between groups. PONV and patient satisfaction data [n(%)] are presented in Table 1.

(*p<0.05)

CONCLUSIONS: Prophylactic combination antiemetics with droperidol and ondansetron in the presence of propofol maintained anesthetic are associated with a lower incidence of PONV and greater patient satisfaction compared with isoflurane based anesthetic with similar antiemetic combination. The antiemetic effects of propofol based anesthetic without additional antiemetic is short-lived.