• Mark Dershwitz, Piotr Michałowski, YuChiao Chang, Carl E Rosow, and Lydia A Conlay.
• Department of Anesthesiology, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA. mark.dershwitz@umassmed.edu
• J Clin Anesth. 2002 Jun 1;14(4):275-8.

Study ObjectiveTo compare the frequency and duration of postoperative nausea and vomiting (PONV) following total intravenous anesthesia (TIVA) with propofol and either remifentanil or alfentanil in outpatients undergoing arthroscopic surgery of the extremities.DesignRandomized, third-party blinded study.SettingUniversity medical center.Patients100 ASA physical status I and II patients scheduled for arthroscopic surgery of the knee or shoulder.InterventionsThe anesthesia regimen consisted of a bolus followed by continuous infusion of propofol (2 mg/kg followed by 120 microg/kg/min) and the opioid (remifentanil 0.5 microg/kg followed by 0.1 microg/kg/min or alfentanil 10 microg/kg followed by 0.25 microg/kg/min). Patients breathed 100% oxygen spontaneously through a Laryngeal Mask Airway (or an endotracheal tube when medically indicated). Opioids were titrated to maintain blood pressure and heart rate within 20% of baseline and a respiratory rate of 10 to 16 breaths/min. Propofol was titrated downward as low as possible without permitting patient movement.MeasurementsNausea was determined by an 11-point categorical scale and was recorded before surgery and multiple time points thereafter. The times of emetic episodes were recorded. Treatment of PONV was at the discretion of the postanesthesia care unit (PACU) nurses who were blinded to the identity of the opioid used.Main ResultsNausea scores were 0 at all time points in over 70% of the patients in each group. None of the 100 patients vomited while in the hospital, and only one patient required antiemetic therapy.ConclusionWhen propofol-based TIVA is used for arthroscopic surgery, short-acting opioids do not significantly affect the risk of PONV.

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