Patient-controlled antiemesis - A randomized, double-blind comparison of two doses of propofol versus placebo

Background: The role of propofol for the management of postoperative nausea and vomiting (PONV) is not well established This study determines the effi cacy of small doses of propofol administered by patient-controlled device f or the treatment of PONV. Methods: Patients presenting for ambulatory surgery received a standardized general anesthetic. Those who experienced significant nausea or emesis wit hin 1 h of arrival hi the recovery room mere randomized to receive repeated doses of propofol 20 mg (P-20), propofol 40 mg (P-40), or intralipid (plac ebo) on demand. Study medications (in equal volumes) were administered with a patient-controlled delivery device for 2 h, A lockout interval of 5 min between doses was used. The following parameters were assessed: nausea, vom iting, rescue antiemetic use, recovery profile, study drug administration h istory, and satisfaction with treatment. Results: Sixty-nine patients participated in the study, Patient demographic s were similar. The average nausea score for a patient in the P-20 and P-40 groups was 25% and 29% less, respectively, compared with placebo during th e study period (P < 0.05). This difference was apparent 15 min after initia tion of therapy. More placebo patients vomited (P-20, 12%; P-40, 23%; place bo, 56%; P = 0.003) and needed rescue antiemetics (P-20, 17%; P-40. 23%; pl acebo, 70%; P = 0.001) compared with treatment groups, Sedation scores were similar between groups, Propofol-treated patients had shorter stays in the post-anesthesia care unit (PACU; P-20, 131 +/- 35 min [mean +/- SD]; P-40, 141 +/- 34 min; placebo, 191 +/- 92 min; P = 0.005) and higher satisfactio n with their control of PONV than placebo (P < 0.01), Conclusions: Propofol is effective in managing PONV with shorter PACU stay and great degree of patient satisfaction. There were two episodes of overse dation in the P-40 group. Hence, propofol at a demand dose of 20 mg seems m ore appropriate.