The use of propofol for its antiemetic effect: A survey of clinical practice in the United States

Study Objectives: To investigate the use of propofol by anesthesiologists for its antiemetic effect and to compare our findings with published evidence. Design: Anonymous survey of U.S. anesthesiologists. Setting: American Society of Anesthesiologists annual meeting Measurements and Main Results: One hundred fifty anesthesiologists were surveyed on how they use propofol to achieve an antiemetic effect. A large majority (84%) of the anesthesiologists surveyed stated they used propofol for its antiemetic effect: 63% of those used propofol for induction only for casts lasting <1 h to achieve an antiemetic effect. In addition 37% used a sandwich technique using propofol at the beginning and end of a case for a similar purpose. There is evidence that the antiemetic effect of propofol is associated with a defined plasma concentration range; mean, 343 ng/mL (10-90% confidence intervals [CI] 200-600 ng/mL). Simulation data demonstrated that after propofol 2 mg/kg, its concentration will drop below 350 ng/mL at 32 min. After 2 mg/kg and 20 ng within 10 min of the end of surgery, its concentration will drop below 350 ng/mL by 7 min after the 20 mg bolus dose. This finding suggests that the plasma concentrations of;propofol, when used in these cases, will be below the effective range of antiemetic effect. Conclusions: Many anesthesiologists used propofol for its antiemetic effect. There is strong evidence for its antiemetic efficacy after anesthesia maintained by a propofol infusion and also for its use in the postanesthesia care unit (PACU). However, there is little evidence to support its use purely at induction of anesthesia or ns part of a sandwich technique in an attempt to reduce postoperative nausea and vomiting. This is especially true in cases lasting longer than a few minutes. (C) 2000 by Elsevier Science Inc.