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Nausea and Vomiting After Strabismus-Surgery: A Randomized Comparison of Isoflurane, Enflurane, Sevoflurane and Propofol

Background: Previous studies reported that propofol anesthesia is an effective means of preventing postoperative nausea and vomiting (PONV) after different types of surgeries. The present analysis of a large antiemetic trial is intend to compare propofol versus isoflurane, enflurane or sevoflurane with respect to the incidences of PONV after strabismus surgery. Methods: 238 ASA I - III inpatients, aged 4-65 years were randomly assigned to receive either isoflurane (group I, n = 60), enflurane (group E, n = 59), sevoflurane (group S, n = 59) or propofol (group P, n = 60) for maintenance as a subgroup of a larger trial of factorial design to investigate interventions to reduce PONV. After opioid application, patients in the inhalational groups (group I, E and S) had anesthesia induced with thiopental, those in group P received propofol for induction. Tracheal intubation was facilitated with succinylcholine. Patients were ventilated with N2O/O2 2:1. Incidence and severity of PONV as well as the need for antiemetic rescue treatment were studied during the first 24 hours after anesthesia. Paracetamol and tramadol was given to treat postoperative pain. Results: There were no significant differences between study groups with respect to patient demographics and risk factors for postoperative nausea and vomiting. Nausea was reported by 43%, 41%, 42% and 22% of patients in groups I, E, S and P, respectively (P = 0.043). The incidence of vomiting was 40%, 46%, 34% and 18% in groups I, E, S and P, respectively (P = 0.011). Conclusion: Patients anesthetized with propofol showed a significantly lower incidence of nausea and vomiting compared to volatile anesthetics, while there was no significant differences in emetogenicity between the volatile anesthetics.