School of Anesthesiology, Weifang Medical University, Weifang, China.
Department of Anesthesiology, Weifang People's Hospital, Weifang, China.
Medicine (Baltimore). 2023 Mar 10;102(10):e33249. doi: 10.1097/MD.0000000000033249.
To observe the effect of low-dose propofol combined with dexamethasone on the prevention of postoperative nausea and vomiting (PONV) in gynaecological day surgery under remimazolam-based general anesthesia.
A total of 120 patients, aged from 18 to 65 years old, American Society of Anesthesiologists grade I or II, were scheduled to undergo hysteroscopy under total intravenous anesthesia. The patients were divided into 3 groups (n = 40 each): dexamethasone plus saline group (DC group), dexamethasone plus droperidol group (DD group) and dexamethasone plus propofol group (DP group). Dexamethasone 5 mg and flurbiprofen axetil 50 mg were given intravenously before induction of general anesthesia. Anesthesia induction: remimazolam 6 mg/kg/hours was continuously pumped until sleep and slow intravenous injection of alfentanil 20 ug/kg and mivacurium chloride 0.2 mg/kg was given. Anesthesia maintenance: remimazolam 1 mg/kg/hour and alfentanil 40 ug/kg/hours were continuously pumped. After the start of surgery, DC group was given 2 mL saline, DD group was given droperidol 1 mg, and DP group was given propofol 20 mg. Primary outcome: incidence of PONV in the postanesthesia care unit (PACU). Secondary outcome: incidence of PONV in patients within 24 hours after surgery, as well as general patient data, duration of anesthesia, the recovery time of patients, dose of remimazolam and alfentanil, etc.
In PACU, patients of group DD and DP showed less PONV than those in group DC (P < .05). Within 24 hours after operation, there was no significant difference in the incidence of PONV among the 3 groups (P > .05), but the incidence of vomiting in DD group and DP group was significantly lower than that in DC group (P < .05). There was no significant difference in general data, anesthesia time, the recovery time of patients and dosage of remimazolam and alfentanil among the 3 groups (P > .05).
The effect of low-dose propofol combined with dexamethasone to prevent PONV under remimazolam-based general anesthesia was similar to that of droperidol combined with dexamethasone, both of which significantly reduced the incidence of PONV in the PACU compared to dexamethasone alone. However, low-dose propofol combined with dexamethasone had little effect on the incidence of PONV within 24 hours compared to dexamethasone alone and only reduced the incidence of postoperative vomiting in patients.
观察小剂量丙泊酚联合地塞米松预防依托咪酯全麻下妇科日间手术术后恶心呕吐（PONV）的效果。
择期全身静脉麻醉下行宫腔镜手术患者 120 例，年龄 18～65 岁，美国麻醉医师协会（ASA）分级Ⅰ或Ⅱ级，随机分为 3 组（每组 40 例）：地塞米松+生理盐水组（DC 组）、地塞米松+氟哌利多组（DD 组）和地塞米松+丙泊酚组（DP 组）。麻醉诱导前静脉给予地塞米松 5 mg 和氟比洛芬酯 50 mg。麻醉诱导：持续泵注依托咪酯 6 mg·kg-1·h-1 至入睡，缓慢静脉注射阿芬太尼 20 μg/kg 和咪达唑仑 0.2 mg/kg。麻醉维持：持续泵注依托咪酯 1 mg·kg-1·h-1 和阿芬太尼 40 μg·kg-1·h-1。手术开始后，DC 组给予 2 mL 生理盐水，DD 组给予氟哌利多 1 mg，DP 组给予丙泊酚 20 mg。主要结局：麻醉后恢复室（PACU）PONV 发生率。次要结局：术后 24 h 内患者 PONV 发生率，以及患者一般资料、麻醉时间、患者苏醒时间、依托咪酯和阿芬太尼用量等。
PACU 时，DD 组和 DP 组患者 PONV 发生率低于 DC 组（P<0.05）。术后 24 h 内 3 组患者 PONV 发生率比较差异无统计学意义（P>0.05），但 DD 组和 DP 组呕吐发生率低于 DC 组（P<0.05）。3 组患者一般资料、麻醉时间、患者苏醒时间及依托咪酯和阿芬太尼用量比较差异无统计学意义（P>0.05）。
依托咪酯全麻下小剂量丙泊酚联合地塞米松预防 PONV 的效果与氟哌利多联合地塞米松相当，均明显降低了 PACU 中 PONV 的发生率，与地塞米松单用相比，与地塞米松单用相比，24 h 内 PONV 发生率及术后呕吐发生率降低，但差异无统计学意义。
