Randomized controlled trial of total intravenous anesthesia with propofol versus inhalation anesthesia with isoflurane-nitrous oxide - Postoperative nausea and vomiting and economic analysis

Background: To assess the incidence of postoperative nausea and vomiting af ter total intravenous anesthesia (TIVA) with propofol versus inhalational a nesthesia with isoflurane-nitrous oxide, the authors performed a randomized trial in 2,010 unselected surgical patients in a Dutch academic institutio n. An economic evaluation was also performed. Methods: Elective inpatients (1,447) and outpatients (563) were randomly as signed to inhalational anesthesia with isoflurane-nitrous oxide or TWA with propofol-air. Cumulative incidence of postoperative nausea and vomiting wa s recorded for 72 h by blinded observers. Cost data of anesthetics, antieme tics, disposables, and equipment were collected. Cost differences caused by duration of postanesthesia care unit stay and hospitalization were analyze d. Results: Total intravenous anesthesia reduced the absolute risk of postoper ative nausea and vomiting up to 72 h by 15% among inpatients (from 61% to 4 6%, P < 0.001) and by 18% among outpatients (from 46% to 28%, P < 0.001). T his effect was most pronounced in the earl), 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 Isoflura ne versus 115 min after TIVA for inpatients (P < 0.001) and 160 min after i soflurane versus 150 min after TIVA for outpatients (P = 0.039). Duration o f hospitalization was equal in both arms. Conclusion: Propofol TIVA results In a clinically relevant reduction of pos toperative nausea and vomiting compared with isoflurane-nitrous oxide anest hesia (number needed to treat = 6). Both anesthetic techniques were otherwi se similar. Anesthesia costs were more than three times greater for propofo l TWA, without economic gains from shorter stay in the postanesthesia care unit.