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The Use of Propofol as an Antiemetic

From the 19th century to the present day, postoperative nausea and vomiting (PONV) has perplexed generations of anesthesiologists. The incidence in untreated patients undergoing general anesthesia remains high, with rates ranging from 1% to 43%. Various drugs can be used for prophylaxis against PONV, but most have a significant side effect profile. Thus, an anesthetic agent that prevents nausea would be highly desirable. Propofol (2,6-diisopropylphenol; Diprivan, AstraZeneca Pharmaceuticals, Wilmington, DE) has gained a reputation as the intravenous anesthetic least likely to cause PONV. Moreover, studies comparing propofol with other anesthetics suggest that propofol has an antiemetic effect. In 1988, McCollum and colleagues reported that patients induced and maintained with propofol had a lower incidence of postoperative nausea and vomiting than a control group under methohexital. This finding has been both verified and rejected by subsequent research. Recent breakthroughs have refined the understanding of this novel property of propofol. A dose-response curve has been defined, optimum delivery systems have been proposed, and mechanisms of action have been hypothesized. This article will summarize the most recent work in this field as well as discuss the appropriate clinical use of propofol as an antiemetic.