Effect of multi-intervention with a small dose of propofol and dexamethasone compared with dexamethasone alone on postoperative nausea and vomiting in pediatric moyamoya patients

Abstract

Background: Pediatric moyamoya patients undergoing encephalo-duro-arterio-synangiosis (EDAS) surgery are at high risk for postoperative nausea and vomiting (PONV). This prospective, randomized, observer-blind study was designed to evaluate the antiemetic effect of subhypnotic dose of propofol combined with dexamethasone. Method: Sixty moyamoya patients who were aged 4-17 yr and underwent EDAS surgery under standardized anesthetic technique followed by postoperative pain control with fentanyl i.v. infusion were included. At dural closure, we administered either normal saline and 0.15 mg/kg dexamethasone (Group D) or 0.5 mg/kg propofol and 0.15 mg/kg dexamethasone (Group DP). As statistical analysis, generalized linear mixed model (GLMM) for repeated measure binary outcomes (nausea and vomiting) and also linear mixed model (LMM) for repeated measure continuous outcome (pain score) were used. Time and group were modeled as fixed effects with primary objectives as the dependent variables. P value of less than 0.05 was considered significant. Result: The incidence of nausea and vomiting did not differ between two groups during study period. More than 80% of patients in Group D and 63.3% of patients in Group DP complained of nausea during the early period (~ 6 hr) without statistical significance. The incidence of nausea in both groups decreased to 30-40% during the late period (6-24 hr). There were no differences in the number of patients who required rescue antiemetic between the two groups. Conclusion: A small dose of propofol combined with dexamethasone may not increase antiemetic effect in pediatric moyamoya patients undergoing EDAS surgery compared with prophylactic dexamethasone alone.