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Correspondence |
Tsukuba, Japan
To the Editor:
Postoperative nausea and vomiting (PONV) occur frequency after dental surgery, with an incidence as high as 50% when no prophylactic antiemetic is given.1,2 We previously showed that a single small dose (0.5 mg•kg-1) of propofol administered iv at the end of surgery was effective for preventing PONV.3 In the present study, we compared the efficacy of low dose propofol with traditional antiemetics, droperidol and metoclopramide, for the prophylaxis of PONV following dental surgery.
Ninety patients, 32 males and 58 females, aged 15 to 49 yr, scheduled for dental surgery performed under general anesthesia were enrolled. Anesthesia was induced with iv thiopentone 5 mg•kg-1 and fentanyl 2 µg•kg-1, with tracheal intubation facilitated by vecuronium 0.2 mg•kg-1. Anesthesia was maintained using sevoflurane 1.0 to 3.0% and N2O/O2 (2:1). At the end of surgery, patients received iv, in a randomized, double-blinded manner, propofol 0.5 mg•kg-1, droperidol 20 µg•kg-1, or metoclopramide 0.2 mg•kg-1 (n = 30 in each group). The dose of each antiemetic was based on previous studies.1,2,4 Atropine 0.02 mg•kg-1 and neostigmine 0.04 mg•kg-1 were administered iv for reversal of muscle relaxation, and the trachea was extubated. Postoperatively, all episodes of emetic symptoms (nausea, retching, vomiting) from zero to 24 hr after anesthesia were recorded by the nursing staff. The level of sedation was graded on a three-point scale: (0 = awake; 1 = drowsy; 2 = asleep). Statistical analyses were performed by ANOVA, 
2 test, Fisher’s exact probability test, and Kruskal-Wallis rank test. P < 0.05 was considered significant. Results are mean ± SD or n (%). Patient demographics, types of surgery and levels of sedation were not different between groups. The rate of PONV during zero to 24 hr after anesthesia was less in patients who had received propofol (10%) than in those who had received droperidol (37%) or metoclopramide (40%; P < 0.05; Table available as additional material at www.cja-jca.org).
To our knowledge, this is the first report to compare the efficacy of low dose propofol, droperidol, and metoclopramide for the prophylaxis of PONV in patients undergoing general anesthesia for dental surgery. When these antiemetics were administered iv at the end of surgery, a single small dose of propofol was most efficacious without excessive sedation in this population. The exact mechanism by which propofol acts as an antiemetic is unknown, but there is a possibility that reduced levels of serotonin in the area postrema may be related to its antiemetic property.5
References
1 Muir VM, Leonard M, Haddaway E. Morbidity following dental extraction. A comparative survey of local analgesia and general anaesthesia. Anaesthesia 1976; 31: 171–80.[Medline]
2 Smith BL, Young PN. Day stay anaesthesia. A follow-up of day patients undergoing dental operations under general anaesthesia with tracheal intubation. Anaesthesia 1976; 31: 181–9.[Medline]
3 Fujii Y, Uemura A, Nakano M. Small dose of propofol for preventing nausea and vomiting after third molar extraction. J Oral Maxillofac Surg 2002; 60: 1246–9.[Medline]
4 Watcha MF, White PF. Postoperative nausea and vomiting. Its etiology, treatment, and prevention. Anesthesioloy 1992; 77: 162–84.
5 Cechetto DF, Diab T, Gibson CJ, Gelb AW. The effects of propofol in the area postrema of rats. Anesth Analg 2001; 92: 934–42.
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