The Effect of Subhypnotic Doses of Propofol to Treat Postoperative Nausea and Vomiting in a Cardiovascular Surgical Intensive Care Unit

Aim The incidence of postoperative nausea and vomiting (PONV) is 45– 50% for cardiac surgery. Extubation in CVS-ICU is a critical period. when heart changes in rate-pressure and rhythm disorders may occur. Sympathetic stimulation increases myocardial contractility and systemic vascular resistance. and causes myocardial ischemia. arrhythmia and bleeding tendency. Gagging. in turn. can result in bradycardia-hypotension through the activation of the parasympathetic system. Various medications have been recommended for the prevention of PONV in CVS-ICU. The present study examines the effects of subhypnotic doses of propofol-dexamethasone. administered prior to extubation. on PONV and hemodynamic parameters. Material and methods Propofol (iv-10 mg) was administered in P/GP group. dexamethasone (iv-5 mg) in D/GD group and normal saline (iv-2 ml) in K/GK group to 45 patients 10 minutes before extubation. The mean arterial pressure (MAP). heart rate (HR) and oxygen saturation (SpO2) were recorded for 2–10 min pre-injection and post-injection. and 1–5 min post-extubation. Feelings of nausea were assessed using a verbal descriptive scale (VDS). while the Ramsay sedation scale (RSS) was used to evaluate sedation level. Nausea severity. the number of vomiting events. hemodynamic changes and patient complaints for 12 hours post-extubation were recorded. MAP: the difference between 2 min pre-medication and post-medication was significant in GP Results There was no difference at 1–5 min pre- and post-extubation when compared to premedication. but it was significantly higher than pre-extubation. GD was significantly increased only at 1 min post-extubation. and returned to the pre-extubation level at 5 min. The decrease was more significant than that at 1 min post-extubation. There was no difference between pre-medication and post-medication in GK. while it was significantly increased at 1 min post-extubation. A between-group comparison revealed a difference at 2 min post-medication between GP and GD. HR was not significant in any timepoint in GP. It was different at min 1 pre- and post-extubation in GD. The situation was similar for GK. A between-group comparison revealed no difference in measurements. SpO2: intra- and between-group comparisons revealed no differences in any of the three groups. The post-extubation difference in VDS was significant between GP and GD. GP and GK. and GD and GK. There was no difference between GP and GD in other periods. while it was different from GK. A between-group comparison using the RSS revealed the values in GP to be higher than both groups. but the difference was not significant. Complications at 12-hour follow-up included vomiting (3). arrhythmia (4). dizziness (3) and lethargy (4) in GP; hypertension (1) and arrhythmia (2) in GD; and vomiting (2). hypertension (1). arrhythmia (6). dizziness (1). lethargy (2) and pain (2) in GK. Conclusion Pre-extubation propofol and dexamethasone were effective in reducing nausea, but not in preventing vomiting. None of the medication caused any side effects. In addition. extubation was tolerated more comfortably in GP without any difference in RSS.