Comparison between total intravenous anesthesia and inhalation anesthesia in ent surgery: Postoperative nausea and vomiting

Postoperative nause and vomiting (PONV) is still a common problem of anesthesia including delayed discharge and recovery time. In our study we compared total intravenous anesthesia with propofol-remifentanyl and inhalation anesthesia with sevoflurane preventing PONV in Ear Nose Throat (ENT) surgery. We used two different prophylactic antiemetics in order to find out the most adequate modality to prevent PONV After informed consent was obtained, 120 patients ASA I-II class between 18-55 years undergoing ENT surgery including at least one risc factor for PONV were enrolled in the study. Patients were randomized to 6 groups as Grup 1 (TIVA), Grup 2 (TIVA-Dexamethasone), Grup 3 (TIVA-Ondansetron), Grup 4 (Sevoflurane), Grup 5 (Sevoflurane-Dexamethasone), Grup 6 (Sevoflurane-Ondansetron) . For induction of anestesia 1 mcg/kg Fentanyl, 2 mg/kg Propofol, 0,5 mg/kg Atracurium were used to all patients. Maintenance of anesthesia in group 1, 2 and 3 was performed with TIVA using 0,1 mg/kg/min Propofol and iv 0,2 mcg/kg/min Remifentanyl. Maintenance of anesthesia in group 4, 5 and 6 was achieved with %2 Sevoflurane, oxygen and air mixture (%50-%50) and 0,2 mcg/kg/min Remifentanyl infusion. Dexamethasone 8 mg iv was administered immediately after induction to the patients in Group 2 and 5. Ondansetron 4 mg iv was administered at the end of the surgery to the patients in Group 3 and 6. To provide postoperative analgesia Dexcetoprophen or Tenoksicam was administered and also Parasetamol if needed. Opioid derivative drugs were not used in any groups. PONV was recorded in determined time intervals as 0-2, 2-6, 6-24 ( after discharge) hours in patients. All the patients were called by phone after discharge and questioned about PONV severity. PONV severity was determined with verbal descriptive scale. (VDS) In conclusion, if TIVA using propofol and remifentanyl is preffered in ENT surgery, prophylactic antiemetics are not required for the prevention of PONV. When Sevoflurane is used for maintainance of anaesthesia, iv Ondansetron prophylaxis can adequately prevent PONV.