The Effect of Total Intravenous Anesthesia With Propofol on Postoperative Nausea and Vomiting in Patients Undergoing Robot-assisted Laparoscopic Radical Prostatectomy
Condition: Robotic Radical Prostatectomy
MeSH terms: Vomiting; Postoperative Nausea and Vomiting
Study type: Interventional
Phase: Phase 4

Summary: 
      To maximize the surgical visual field, Robot-assisted laparoscopic radical prostatectomy
      (RLRP) usually requires the patient to be positioned in a steep trendelenburg position in
      combination with prolonged intraperitoneal carbon dioxide (CO2) insufflation and increased
      intrabdominal pressure. Insufflations of CO2 during laparoscopic surgery, which causes
      stretch and irritation of the peritoneum, is known to play an important role in postoperative
      nausea and vomiting (PONV). In addition, prolonged pneumoperitoneum increases the risk for
      PONV. PONV can cause patient discomfort and prolong post anaesthesia care unit (PACU) stay.
      In addition, the patient with PONV is also predisposed to severe complications such as
      aspiration pneumonia, increased wound dehiscence, delayed recovery, prolonged hospital stay,
      and eventually increased medical cost.
    

Detailed description: 
      To maximize the surgical visual field, Robot-assisted laparoscopic radical prostatectomy
      (RLRP) usually requires the patient to be positioned in a steep trendelenburg position in
      combination with prolonged intraperitoneal carbon dioxide (CO2) insufflation and increased
      intrabdominal pressure. Insufflations of CO2 during laparoscopic surgery, which causes
      stretch and irritation of the peritoneum, is known to play an important role in postoperative
      nausea and vomiting (PONV). In addition, prolonged pneumoperitoneum increases the risk for
      PONV. PONV can cause patient discomfort and prolong post anaesthesia care unit (PACU) stay.
      In addition, the patient with PONV is also predisposed to severe complications such as
      aspiration pneumonia, increased wound dehiscence, delayed recovery, prolonged hospital stay,
      and eventually increased medical cost. Therefore, as RLRP itself can be an important risk
      factor of PONV, the anaesthesiologist should give attention to prevent PONV in this patient
      group, although they usually have lower risk in terms of patient-related factors. Previously
      published studies have recommended antiemetic prophylaxis for the patients with
      moderate-to-high risk of PONV. However, despite routine use of prophylactic antiemetics,
      laparoscopic surgery has been associated with higher incidence of PONV.Previous clinical
      studies suggested that total intravenous anaesthesia (TIVA) with propofol reduced PONV
      significantly compared to inhaled anaesthetics. Also, several studies have recommended TIVA
      with propofol as the anaesthetic method in patients with high risk of PONV. However none of
      these studies were designed and powered to detect differences in PONV in patients undergoing
      laparoscopic surgery, especially RLRP.
    

Intervention name(s): Propofol anesthesia
Intervention type(s): Drug
Intervention description(s): In the TIVA and TIVA-P group, propofol and remifentanil were used for induction and maintenance of anaesthesia. In the control group, propofol and remifentanil were used for induction and anaesthesia was maintained with desflurane and remifentanil. In the control and TIVA-P group, ramosetron 0.3mg was administered at the end of surgery. In all patients, postoperative pain was controlled with fentanyl-based intravenous patient-controlled analgesia. he depth of anaesthesia was monitored with a bispectral index score monitor and maintained at 40-60.
Intervention MeSH terms: Propofol
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Care Provider, Outcomes Assessor)
Primary purpose: Prevention