News Release
FOR IMMEDIATE RELEASE
Can General Anesthesia-Induced Postoperative Nausea and Vomiting Be Reduced?
Anesthesia Progress – The use of general anesthesia is necessary when undergoing major surgeries, and unfortunately, it comes with an increased risk of postoperative nausea and vomiting (PONV). While PONV is unpleasant in general, it creates heightened complications when accompanying recovery from orthognathic (corrective jaw) surgery. During recovery, there are limitations to opening the mouth so as not to strain the jaw, and vomiting may induce serious issues like airway obstruction and even pulmonary aspiration. Medications, such as propofol along with remifentanil, have traditionally been used to help reduce PONV; however, some believe remimazolam could be a better alternative to propofol. Determining the optimal medications to reduce PONV is crucial to patient recovery.
To assess which medications will best reduce PONV, as well as instances of hypotension, in patients after orthognathic surgery, researchers from Tokyo Dental College in Tokyo, Japan, recently published a study in the current issue of Anesthesia Progress. Lead author Rumi Kaneko, DDS, and colleagues state, “Our primary objectives were to retrospectively compare the incidence of early and late PONV and assess any episodes of hypotension between [propofol and remimazolam along with remifentanil].”
A total of 125 patient cases were reviewed and evaluated; 84 were included in the propofol group and 41 in the remimazolam group, with no significant differences in patient characteristics between groups. Patient cases were included if the patients were in good overall health, under the age of 60 years, and underwent orthognathic surgery between January 2021 and March 2022. Patient records were examined to gather data on early (up to 2 hours) and late (2-24 hours) PONV and intraoperative hypotension.
Researchers found that early PONV was significantly lower in the propofol group (9.5%) compared with the remimazolam group (34.1%); however, late PONV appeared insignificant (36.9% vs. 51.2%, respectively). They also noted a higher occurrence of intraoperative hypotension in the propofol group (22.6%) than in the remimazolam group (2.4%), yet there were no differences in the average intraoperative systolic blood pressure or vasopressor administration.
The study results suggest that propofol, compared with remimazolam, has a lower incidence of early PONV but a higher incidence of intraoperative hypotension. “However, given that over 33% of patients still developed late PONV regardless of the anesthetic agent used, it is likely necessary to administer antiemetics prophylactically for orthognathic surgery.” Kaneko and colleagues go on to further state, “On the other hand, there was no significant difference in the average intraoperative systolic blood pressure between [total intravenous anesthesia] with propofol vs remimazolam during general anesthesia for orthognathic surgery in young, healthy adults.”
Full text of the article, “Retrospective Study on the Incidence of Postoperative Nausea and Vomiting and Hypotension During Orthognathic Surgery Using Propofol or Remimazolam,”Anesthesia Progress, Vol. 71, No. 1, 2024, is now available at https://doi.org/10.2344/23-00002
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About Anesthesia Progress
Anesthesia Progress is the official publication of the American Dental Society of Anesthesiology (ADSA). The quarterly journal is dedicated to providing a better understanding of the advances being made in the science of pain and anxiety control in dentistry. The journal invites submissions of review articles, reports on clinical techniques, case reports, and conference summaries. To learn more about the ADSA, visit: http://www.adsahome.org/.
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