Prevention of postoperative nausea and vomiting with antiemetics in patients undergoing middle ear surgery: comparison of a small dose of propofol with droperidol or metoclopramide.

OBJECTIVE To compare the efficacy and safety of a small dose of propofol with other commonly used antiemetics, droperidol and metoclopramide, for the prevention of postoperative nausea and vomiting in patients undergoing middle ear surgery. DESIGN Prospective, randomized, double-blind study. SETTING University-affiliated teaching hospital. PATIENTS Ninety patients (48 females, 42 males) scheduled for middle ear surgery. INTERVENTION Patients received propofol, 0.5 mg/kg, droperidol, 20 microg/kg, or metoclopramide hydrochloride, 0.2 mg/kg, intravenously at the end of the surgical procedure. A standardized general anesthetic technique was employed throughout the surgical procedure. MAIN OUTCOME MEASURE Emetic episodes and safety assessment were performed during 2 periods-0 to 3 hours in the postanesthetic care unit and 3 to 24 hours in the ward-after receiving anesthesia. RESULTS The incidence of patients who were emesis free during the 0- to 3-hour period after receiving anesthesia was 93% for those who received propofol, 73% for those who received droperidol, and 70% for those who received metoclopramide, respectively; the respective corresponding incidence during the 3- to 24-hour period after receiving anesthesia was 90%, 67%, and 60% (P<.05, overall Fisher exact probability test). No clinically adverse events were observed in any of the groups. CONCLUSION A small dose of propofol is a better antiemetic than droperidol or metoclopramide for the prevention of postoperative nausea and vomiting after middle ear surgery.