Gan, T.J.; (2008) Propofol for the management of postoperative nausea and vomiting (PONV). Doctoral thesis , University of London.

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Abstract

Postoperative nausea and vomiting (PONV) is one of the most common complications following surgery. Despite better anaesthetic techniques, and the availability of newer generations of antiemetics, the incidence of PONV is still as high as 60-70% in high-risk subjects. Patients rated symptoms of nausea and vomiting as highly undesirable and are willing to pay out of pocket a substantial amount for an effective antiemetic. PONV also has major economic implications, prolonging recovery room and hospital stay, and in some cases, increases patient morbidity. Propofol is an intravenous anaesthetic which gained rapid popularity due to its favourable pharmacokinetic and pharmacodynamic profile. In particular, it is associated with rapid recovery, making it the intravenous anaesthetic agent of choice especially in ambulatory anaesthesia. Previous studies have demonstrated that total intravenous anaesthesia with propofol is associated with a lower incidence of PONV when compared with inhalational anaesthetic. However, it is unclear regarding the dose response of propofol when used as an antiemetic, and how propofol should be administered in the perioperative period for its antiemetic effects. The over arching goal of this MD thesis is to examine the use of propofol for its antiemetic properties. First, we assessed the extent of clinical practice of using propofol for its antiemetic effects among US anaesthesiologists. Next, we determine the dose response of propofol for its antiemetic effects. We examined the efficacy of propofol when used as antiemetic prophylaxis as well as for the treatment of established PONV. Different regimens of propofol administration were assessed for its prophylactic antiemetic effects. Treatment of established PONV was assessed using a patient controlled antiemetic system. We also determined the use of propofol in a multimodal PONV prevention strategy as well as its use in paediatric population. The main objective of these series of investigations was to systematically determine the antiemetic effects of propofol and recommend how propofol should be used in clinical practice.

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