Intraoperative Infusion of Sub-Hypnotic Propofol as Prevention for PONV: A Systematic Review

Document Type

Conference Proceeding

Publication Date

10-12-2025

Abstract

Background: Postoperative nausea and vomiting (PONV) is one of the most common anesthetic complications that negatively affects patient satisfaction and healthcare costs. Propofol is a well-established antiemetic when used as an infusion during total intravenous anesthesia (TIVA) or combined intravenous and volatile anesthetic (CIVA). This systematic review aims to determine if an intraoperative subhypnotic propofol infusion (SHPI) during a volatile general anesthetic also prophylactically decreases the rate of PONV. Methods: All randomized controlled trials (RCT) utilizing an intraoperative SHPI defined at < 33mcg/kg/min as a preventative treatment for PONV were identified through the systematic review tool, Rayyan. Data including surgical and anesthetic times, patient demographics, and PONV rates were extracted. Outcomes were measured by odds ratios (OR) with a 95% confidence interval (CI). Results: A total of 7 studies with 678 patients met inclusion criteria. Statistical analysis included three groupings: SHPI compared to placebo, SHPI + secondary antiemetic compared to only secondary antiemetic, and SHPI compared to dexamethasone. Odds ratios were 0.25[0.15; 0.43], 0.28[0.16; 0.49], 1.00[0.47; 2.14], respectively, which demonstrated SHPI’s effectiveness as a prophylactic treatment for PONV. Conclusion: SHPI is an effective agent in prevention of PONV as both a single agent and in combination with other antiemetics during a volatile based general anesthetic. Additionally, a SHPI has clinical utility as it is widely available and does not affect duration of anesthetic or surgical procedure.

Comments

American Society of Anesthesiologists, The Anesthesiology Meeting, October 10-14, 2025, San Antonio, TX

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