The risk of postoperative nausea and vomiting between surgical patients received propofol and sevoflurane anesthesia: A matched study

Objectives

The current consensus guidelines for managing postoperative nausea and vomiting (PONV) suggest that one of anesthetic risk factors is the use of volatile anesthetics. However, in clinical settings, it is rare to perceive propofol to be superior to volatile anesthetics for the prevention of PONV. To assess whether PONV is related to the type of anesthetic delivered, we compared the incidence and duration of PONV between propofol anesthesia and sevoflurane anesthesia.

Methods

We performed a retrospective review of an institutional registry containing 21606 general anesthesia cases conducted following ethics board approval. Anesthesia for all patients was managed with propofol or sevoflurane. To avoid channeling bias, a propensity score analysis was used to generate a set of matched cases (propofol anesthesia) and controls (sevoflurane anesthesia), yielding 2554 matched patient pairs. The incidence and sustained rate of symptoms were compared as the primary outcomes.

Results

In the unmatched population, a higher incidence of PONV occurred following propofol anesthesia compared to sevoflurane anesthesia (propofol vs. sevoflurane anesthesia: 18.9% vs. 15.3%, respectively, p < 0.0001). The sustained rate of PONV over the course after propofol anesthesia was also higher than that following sevoflurane anesthesia (p < 0.001). Conversely, less PONV occurred after propofol compared to sevoflurane after propensity matching (propofol vs. sevoflurane anesthesia: 20.4% vs. 23.3%, respectively, p = 0.01). However, the sustained rate of PONV over the course after propofol anesthesia did not differ from that following sevoflurane anesthesia (p = 0.09).

Conclusions

Propofol could decrease the incidence of PONV compared with sevoflurane, although the duration of PONV was not affected as found in previous reports.