Published in Anesthesia Progress, this retrospective study is
presented to determine and compare incidence of early and late PONV
and determine any hypotension episodes when propofol, remimazolam
or remifentanil are used.
LAWRENCE, Kan. ,
May 17,
2024 /PRNewswire-PRWeb/ -- 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.
Study results suggest that propofol,
compared with remimazolam, has a lower incidence of early PONV but
a higher incidence of intraoperative hypotension
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://www.doi.org/10.2344/23-00002
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/.
Media Contact
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SOURCE Anesthesia Progress