The use of propofol for its antiemetic effect: A survey of clinical practice in the United States

Study Objectives: To investigate the use of propofol by anesthesiologists f or its antiemetic effect and to compare our findings with published evidenc e. Design: Anonymous survey of U.S. anesthesiologists. Setting: American Society of Anesthesiologists annual meeting Measurements and Main Results: One hundred fifty anesthesiologists were sur veyed on how they use propofol to achieve an antiemetic effect. A large maj ority (84%) of the anesthesiologists surveyed stated they used propofol for its antiemetic effect: 63% of those used propofol for induction only for c asts lasting <1 h to achieve an antiemetic effect. In addition 37% used a " sandwich" technique using propofol at the beginning and end of a case for a similar purpose. There is evidence that the antiemetic effect of propofol is associated with a defined plasma concentration range; mean, 343 ng/mL (1 0-90% confidence intervals [CI] 200-600 ng/mL). Simulation data demonstrate d that after propofol 2 mg/kg, its concentration will drop below 350 ng/mL at 32 min. After 2 mg/kg and 20 ng within 10 min of the end of surgery, its concentration will drop below 350 ng/mL by 7 min after the 20 mg bolus dos e. This finding suggests that the plasma concentrations of;propofol, when u sed in these cases, will be below the effective range of antiemetic effect. Conclusions: Many anesthesiologists used propofol for its antiemetic effect . There is strong evidence for its antiemetic efficacy after anesthesia mai ntained by a propofol infusion and also for its use in the postanesthesia c are unit (PACU). However, there is little evidence to support its use purel y at induction of anesthesia or ns part of a "sandwich" technique in an att empt to reduce postoperative nausea and vomiting. This is especially true i n cases lasting longer than a few minutes. (C) 2000 by Elsevier Science Inc .