Randomized comparison of two anti-emetic strategies in high-risk patients undergoing day-case gynaecological surgery

Background: Postoperative nausea and vomiting (PONV) is a significant causeof morbidity among patients undergoing general anaesthesia.The optimal strategy for prevention of PONV, however, remainsunclear. This study compared two commonly used prophylacticstrategies in high-risk, day-case, gynaecological surgery patients. Methods: We conducted a randomized trial comparing sevoflurane combinedwith dolasetron (SD), with propofol-based total intravenousanaesthesia (TIVA) in 126 high-risk patients undergoing day-casegynaecological surgery. The primary endpoints included the incidenceand severity of nausea or vomiting before discharge and theincidence of nausea or vomiting between discharge and 24 h.To identify the factors most predictive of a complete response(no PONV at any time within the 24 h period), multiplelogistic regression models were fitted. Results: Before discharge, there was no significant difference betweenthe two treatment groups with respect to nausea and vomitingoutcomes (P = 0.3). Post-discharge nausea and vomiting (PDNV),however, were significantly more common for patients in theTIVA group (nausea, P = 0.004 and vomiting, P = 0.03). Typeof anaesthetic, adjusted for weight and anaesthesia durationwas significantly associated with complete response (odds ratio= 2.7, 95% confidence interval = 1.15 to 6.4). Conclusions: Although both TIVA and dolasetron prophylaxis reduce the predictedrate of PONV in the early postoperative period, the anti-emeticeffects of propofol are short-lived. A longer-acting drug suchas dolasetron may therefore be necessary to prevent PDNV.