Effect of low-dose propofol infusion with sevoflurane versus propofol-only total intravenous anesthesia on postoperative nausea and vomiting in high-risk patients: a single-blind randomized controlled clinical trial.

BACKGROUND

Postoperative nausea and vomiting (PONV) is a common complication following general anesthesia, and may lead to delayed recovery and prolonged hospital length of stay. While propofol has been shown to reduce PONV risk, volatile anesthetics like sevoflurane are associated with a higher incidence.

OBJECTIVE

This study compares the incidence of PONV within 24 h after surgery between propofol based total intravenous anesthesia (TIVA) and a hybrid technique using low-dose propofol infusion with sevoflurane in patients with a prior history of PONV and/or motion sickness.

DESIGN

A prospective, single-blind, randomized controlled clinical trial was conducted in adult patients undergoing laparoscopic surgery at Penn State Health Milton S. Hershey Medical Center from February 2024 to March 2025. INTERVENTION: Patients received either TIVA or a low-dose propofol infusion combined with sevoflurane. The primary outcome was the cumulative incidence of PONV within 24 hours postoperatively. Secondary outcomes included PONV in the post-anesthesia care unit (PACU) and use of rescue antiemetics.

RESULTS

A total of 65 patients were included, (32 hybrid anesthesia, 33 propofol TIVA). PONV occurred in 28% of patients receiving hybrid anesthesia compared to 21% receiving TIVA (p = 0.44). At 24 h, PONV was reported by 59% in the hybrid group and 42% in the TIVA group (p = 0.17).

CONCLUSION

Low-dose propofol infusion combined with sevoflurane resulted in PONV rates that were not statistically different from propofol-based TIVA. Trial registration: NCT05759481, registered on 02/22/2023.