Journal of Population

Therapeutics & Clinical

Pharmacology
RESEARCH ARTICLE
DOI: 10.53555/jptcp.v30i17.2630

‘’TO STUDY THE ANTIEMETIC PROPERTIES OF PROPOFOL

IN ABDOMINAL SURGERIES’’
Dr. Rashmi Gupta1*, Dr. Sneha Gupta2, Dr Pramod Pandey3, Dr. Nishitha Divakar4
1
*Senior Resident, Department Of Anaesthesiology, Sms Medical College, Jaipur
2
Md, Dnb Anaesthesiology, Ex. Senior Resident Gmc Shahdol Mp
3
Department Of Anaesthesiology King George's Medical University, Lucknow, Uttar Pradesh, India
226003
4
Md Anaesthesiology, Senior Resident Nscb Medical College Jabalpur Mp

*Corresponding Author: Dr. Nishitha Divakar

*Md Anaesthesiology, Senior Resident Nscb Medical College Jabalpur Mp

Abstract
Background: Postoperative Nausea and Vomiting (PONV) is a dreadful and uncomfortable
experience that significantly detracts patient's quality of life after surgery. Symptoms affecting
patients undergoing abdominal surgery under general anaesthesia. It is also associated with
complications such as gastric aspiration, bleeding, dehydration, wound dehiscence and delayed
hospital discharge. Use of volatile anesthetic agents, prolonged duration of surgery, pain/anxiety,
women, nonsmokers, obesity, use of opioids are certain factors which are proven to increase the
incidence of PONV. The present study compared the antiemetic effect of ondansetron versus
propofol for prevention of postoperative nausea and vomiting in patients undergoing open
abdominal surgery under general anaesthesia.
Objectives: ‘’To study the antiemetic properties of propofol in abdominal surgeries’’
Methods: This study was conducted in the Department of Anaesthesiology & Critical Care, Dr. S.
N. Medical College, and Jodhpur after obtaining institutional ethical committee approval and
written informed consent from study subjects. Patients meeting the inclusion criteria were included
in the study between august 2021 to January 2022. This was a prospective Double Blind
Randomized Comparative Trial. The patients were divided into two groups of 35 each and were
allocated to the groups by computer generated random number table method as follows:
1. Group P: Patients receiving Propofol
2. Group O: Patients receiving Ondansetron
In the post-operative period, incidence of nausea and vomiting was diagnosed by the use of PONV
score and VNRS scale and sedation by Ramsay sedation score for postop till stay in PACU, along
with Aldrete score for discharging patients from PACU. Time for extubation and time for need of
first rescue antiemetic after extubation was noted. The incidence of PONV and mean total frequency
of rescue antiemetic used in 24 hour postoperatively among the two groups was compared.
Results & Discussion -

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 ‘’To Study The Antiemetic Properties Of Propofol In Abdominal Surgeries’’

Results were analysed statistically and were discussed as under. Demographics and Haemodynamic
changes were minimal between both groups and statistically not significant. At time 0hr, 2hr, 4hr,
6hr, 12hr and 24 hr postoperatively we compared nausea and vomiting score in patients of P and O
group. It is statistically not significant (P>0.05) in terms of requirement of mean dose of rescue
antiemetic 24 hrs postop. Incidence of PONV is statistically significant at 5-6hr for group P and at
6-7 hour for group O postoperatively. So sub hypnotic dose of propofol 30 mg is comparable to
ondansetron for reducing the incidence of nausea and vomiting in abdominal surgeries for first 6
hours, when they administered as a bolus 15-20 minutes before skin closure in adults undergoing
abdominal surgeries under sevoflurane anaesthesia. Time for extubation in group O was 14.31±1.15
mints and in group P was 14.6±2.00 minutes. Time to stay in PACU after recovery room discharge
was 83.91±9.22 minutes in group O and 81.45±7.29 in group P. Both results are comparable in both
groups and statistically not significant. Time for first rescue antiemetic dose in group O was
7.18±0.76 hrs. and in group P, it was 5.55±0.52 hours. So we can infer that patients with propofol as
antiemetic for postop PONV prophylaxis requires rescue antiemetic earlier than patients with
ondansetron as prophylaxis. Mean Sedation score in first two hours postop was 1.31±0.47 in group
O and 1.49±0.51 in group P, Mean Aldrete score for discharge from PACU for first two hours
postop was 9.54±0.51 in group O and 9.4±0.5 in group P. Both results are comparable in both
groups and statistically not significant. Difference in the overall incidence of side effects observed
of both groups was statistically insignificant (P> 0.05).
Conclusion: From this study it can be concluded that sub hypnotic dose of propofol is comparable
to ondansetron as conventional therapy for preventing PONV in patients undergoing general
anaesthesia for abdominal surgery in terms of incidence and severity of nausea and vomiting and
requirement of rescue antiemetic.

Keywords- postoperative nausea and vomiting, antiemetic,

INTRODUCTION
Postoperative Nausea and Vomiting (PONV) is a dreadful and uncomfortable experience that
significantly detracts patient's quality of life after surgery. Despite the increasing fear of pain after
surgery, patients still consider PONV to be a significant concern or complication of anaesthesia.
When questioned about issues of concern, 22% of 800 patients in a study gave PONV the highest
level of concern compared with 34% for postoperative pain and 24% for waking up during surgery.1
The associated morbidity with PONV includes decreased patient satisfaction, delayed hospital
discharge, and unexpected hospital readmission. It can also contribute to wound dehiscence,
bleeding, pulmonary aspiration, oesophageal rupture, and fluid and electrolyte disturbances.2

PONV can cause severe discomfort amongst patients and is probably related to several factors,
which include age, sex, operation type, and anaesthesia-related factors.. [5,6,7] Other factors, including
obesity, a history of motion sickness and/or a history of previous postoperative emesis, and also
preoperative volume loading may have an important role in PONV.[8,9,10]

The direct effect of vagal afferents and stimulation of receptors due to the release of 5HT from the
enterochromaffin cells, due to surgical manipulation of intestine stimulates vomiting centre which
results in emesis. Post-operative nausea and vomiting incidence over 24 hours was 42% for
abdominal surgery compared with other surgical procedures (36%). 11

Many different drugs are available for treatment of PONV like phenothiazine (chlorpromazine,
promethazine, dixyrazine), butyrophenones (domperidone, droperidol), antihistaminic (hydroxyzine,
cyclizine), anticholinergic (scopolamine, hyoscine), benzamides (metoclopramide), and serotonin
antagonists (ondansetron, graniesetron).12

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 ‘’To Study The Antiemetic Properties Of Propofol In Abdominal Surgeries’’

Propofol has been universally accepted as an anaesthetic since its approval by the Food and Drug
Administration and introduction into clinical practice in 1989.14 With respect to anaesthetic agents,
nitrous oxide (N2O) and volatile anaesthetics increase the occurrence of PONV, but Propofol is
known to have an antiemetic effect.15

Although propofol was initially accepted as an induction and maintenance hypnotic agent, its
clinical use has remarkably expanded over the past 30 years. In this study, we focused on unique
antiemetic properties of propofol. The mechanisms of antiemetic effects are not completely
elucidated. Many investigators had conducted a variety of studies to identify the mechanism.

This study was planned to compare intravenous ondansetron and propofol for prevention of PONV
in patients undergoing open abdominal surgery under general anaesthesia.

MATERIALS AND METHODS

STUDY DESIGN: Interventional Randomised Comparative Trial

STUDY SITE: The present study was conducted in the department of anaesthesiology and critical
care DR. S.N. MEDICAL COLLEGE AND ATTACHED GROUP OF HOSPITALS, JODHPUR,
after obtaining institutional ethics committee approval and written informed consent from study
subjects.

STUDY PERIOD: August 2021 to January 2022

SAMPLE SIZE:
Sample size was calculated at alpha error 0.05 and study power 80% using the formula for
hypothesis testing for two population mean -
Sample size was calculated to be a minimum of 32 subjects in each group, which was round to 35
subjects in each group.

STUDY POPULATION:
INCLUSION CRITERIA:
Patients of age 18 years to 60 years of either sex, belonging to ASA Physical Status category 1 & 2
undergoing elective open abdominal surgery under general anaesthesia were included.

EXCLUSION CRITERIA: Following patients were excluded from study:

1. Who refuse to give written informed consent,
2. Haemodynamically unstable (patient in shock or on vasopressor support),
3. Patient with BMI less than 18.5 & with more than or equal to 30.0
4. Positive history of drug allergy/allergy to study drugs,
5. On steroid therapy or opioids therapy, or medications causing nausea/vomiting,
6. Pregnant and lactating patient,
7. With a history of motion sickness.

RANDOMISATION TECHNIQUE
The patient's randomization was done by computer-generated random number table, and group
allocation was done by sealed opaque envelope method, which was opened just before induction of
anesthesia. All patients were randomly allocated into two equal groups of 35 each.
1. Group O received IV ondansetron 4mg 20 minutes before closure
2. Group P received IV propofol 30 mg 20 minutes before closure.

Blinding: The bolus of drugs of different volumes and colors was prepared by an anesthesiologist,
who was different from the one administering the drug (drug syringe was wrapped around by
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micropore adhesive) and assessing the patient parameters. To avoid bias, the patient, observers, and
attending anesthesiologists were blinded to the study group, not aware of the preparation of drug
and group allocation. If patient reported any unanticipated side effects, then, code of blinding was
decoded, on an immediate action and drug causing unanticipated event was reported and managed
as per standard treatment protocol.
INVESTIGATION REQUIRED:-
Blood investigations: Haemoglobin (Hb) %, bleeding time, clotting time, prothrombin time, INR,
serum urea, serum creatinine, blood sugar, blood grouping and cross matching. Electrocardiography
(ECG) and Chest X-ray posterior anterior view depending on the age and associated comorbities.
Test to rule out Human immuno deficiency virus, hepatitis B surface antigen, or hepatitis C virus
antigen infection and RT-PCR for COVID-19.

PREANAESTHETIC ASSESSMENT
Patients posted for the elective surgery did undergo a thorough preoperative evaluation which
included proper history, general condition of the patient, and examination of CVS, Respiratory
system, CNS, vertebral columns, and airway assessment. Haemoglobin, packed cell volume, platelet
count, bleeding time, clotting time, renal function test, liver function test, electrocardiogram (ECG),
and chest X-ray PA view were done preoperatively. Patients who fulfilled the inclusion criteria were
included in the study. They were explained about the planned surgery, the anesthetic procedure, and
the study in detail and proper informed written consent from the patient was obtained. The nil by
mouth instruction was given one day prior to surgery as per institutional guidelines.

After taking the patient in the operation theatre, the patient was monitored using pulse oximetry
(SPo2), non-invasive B.P. (NIBP), and continuous ECG. A peripheral intravenous (IV) line was
secured with an 18 G cannula on the forearm, and a 0.5ml/kg/hr crystalloid solution was started.

Premedication was given with inj. fentanyl 2µg.kg-1, inj. lignocaine 1-1.5 mg.kg-1, and inj.
Midazolam 0.03mg/kg IV. Preoxygenation [3-minute tidal volume breathing using an oxygen flow
of 5 l/min] with 100% oxygen was done via a close breathing circuit of anaesthesia workstation.
Then anaesthesia was induced with inj. thiopentone sodium [3- 5mg/kg] and muscle relaxant
injection atracurium 0.5mg/kg, and maintained on sevoflurane with 40% oxygen. Patient's ECG,
NIBP, and SPo2 were continuously monitored intraoperatively. Supplemental analgesia was
provided with injection fentanyl (1 μg/kg) IV bolus if H.R. or mean blood pressure (MBP) exceeded
30% of the preoperative values even after an adequate depth of anesthesia. Continuous monitoring
of HR, NIBP, and SpO2 were done every 15 min till the end of surgery. All the patients were given
Inj. Paracetamol 15mg/kg at 30 min before end of surgery and repeated every 6 hourly for the first
24 hours postoperatively. Twenty minutes before the end of skin closure, patients were administered
either 4 mg ondansetron (Group O) or 30 mg propofol (Group P).

After completion of the surgery, neuromuscular blockade was reversed with injection neostigmine
0.05mg/kg and injection glycopyrrolate 0.01mg/kg. After demonstrating recovery from the muscle
relaxant, patients were extubated and shifted to the recovery room. The total duration of surgery was
noted (only the patients having surgery duration less than or equal to 2 hours were included)
and time to extubation after reversal was noted.

Postoperative Assessment: - After shifting the patient to the recovery room, patients were observed
by data collectors and questioned on outcome variables, such as nausea, vomiting, rescue antiemetic
request, as well as the severity of nausea/vomiting on a numerical rating scale by another data
collector who was blinded to group allocation. PONV score, VNRS, Ramsay sedation score, aldrete
score and haemodynamic parameters were noted.

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Rescue antiemetic (Metoclopramide 10mg) - was given if PONV score equal or greater than 4.
Total frequency of rescue antiemetic used in first 24 hr postoperative period was noted. Any adverse
effects like dizziness, headache, hypotension, allergic reaction, etc., were emphasized.
Haemodynamic variables including pulse rate, SBP, MAP, DBP, SPO2 were recorded every 15
mins intraoperatively and every 30 min for the first hour in the recovery room and then at 2hr, 4hr,
6hr, 12hr, 18hr and 24hr.
The patients were continuously monitored in the recovery room in the first hr by one of anaesthetic.
After that, time duration of patient stay in the PACU was noted.

STATISTICAL ANALYSIS
All statistical analyses were performed using the SPSS software package (SPSS Inc. Chicago, IL,
USA). T-test for independent samples was used to compare two groups for data with normal
distribution, and Mann---Whitney U test was used for comparing data with non-normal distribution.
Yates continuity correction test (Chi-square test), Fisher's exact test, and Fisher Freeman Haltom
test) were used for comparison of qualitative data. All data was summarized as mean ± S.D. for
continuous variables & numbers, and percentages for categorical variables. A p<0.05 was
considered as statistically significant. For multiple comparisons among means, ANOVA with
Fischer's protected least significant difference test. In addition, the differences between these trends
were analyzed by paired t-tests.
➢ A total of 76 subjects were taken for the study, out of these 6 were excluded. Out of 6 patients
excluded, 2 patient’s attenders did not give consent and 4 patients did not meet inclusion
criteria- having presence of hemodynamically instability or prolongation of surgery to more than
120 min. Rest 70 subjects were divided into two groups P and O of 35 subjects each.

These 70 patients were analyzed and the following results were obtained.

OBSERVATIONS AND RESULTS

DEMOGRAPHIC DISTRIBUTION
TABLE 1: AGE WISE DISTRIBUTION OF PATIENTS
Age (yrs) Group O Group P
N % N %
20-30 15 42.86 14 56.00
31-40 9 25.71 6 24.00
41-50 7 20.00 10 40.00
51-60 4 11.43 5 20.00
Median 35 39
Range 20-69 20-69
Mean±SD 36.0±11.1 37.4±12.3
t & p value 0.519, 0.608

Unpaired t test
-The table-1 compares the ages of both groups. The mean ages of the two groups were statistically
non significant (P>0.05).

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TABLE 2: GENDER WISE DISTRIBUTION OF PATIENT

Gender Group O Group P
N % N %
Male 23 65.71 22 62.86
Female 12 34.29 13 37.14
Total 35 100.00 35 100.00

Chi square 0.062, P value 0.803 (NS)

Among all enrolled patients 45 were males and 25 were females. The difference between both sexes
was found statistically non-significant (P > 0.05).

TABLE 3: BMI WISE DISTRIBUTION

BMI Group O Group P
(kg/m2) N % N
18.5-24.9 31 88.57 18.5-24.9 31
25-29.9 4 11.43 25-29.9 4
Median 22.04 22.76
Range 18.95-27.82 18.56-28.19
Mean+SD 22.47+2.03 22.62+2.72
t & p value 0.226, 790 (NS)

Unpaired t test
-table-3 compares the BMI of both groups. The mean BMI of the two groups were statistically non
significant (P>0.05).

TABLE 4: ASA PS WISE DISTRIBUTION OF PATIENT

Group O Group P
ASA
N % N %
I 29 82.86 30 85.71
II 6 17.14 5 14.29
Total 35 100.00 35 100.00

Chi square 0.107, P value 0.742 (NS)

-Among all enrolled patients, the ASA PS classification was found statistically non-significant
(>0.05)

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TABLE 5: Comparison of Intraoperative HR between the group O and P from preop through after
extubation:
Intraoperative Heart Rate (bpm)
Time t value p value
Group O (Mean±SD) Group P (Mean±SD)
Preop 83.54±10.66 83.4±10.41 0.056 0.954
Pre induction 85.49±10.27 83.4±9.29 0.89 0.376
Post induction 87.31±9.99 87.97±9.32 0.284 0.776
Post intubation 86±9.54 85.03±9.19 0.433 0.665
At skin incision 83.03±10.89 80.71±8.81 0.977 0.331
15min 80.91±10.6 78.11±10.83 1.093 0.278
30min 79.03±9.67 78.14±7.5 0.428 0.669
45min 79.03±9.22 78.46±10.92 0.236 0.813
60min 78.06±8.82 79.6±11.07 0.644 0.521
75min 79.31±9.53 80.34±10.87 0.421 0.675
90min 79.77±9.84 81.46±10.89 0.679 0.499
105min 80±8.96 80.91±9.57 0.412 0.681
120min 80.63±8.63 80.31±10.08 0.1401 0.889
After giving drug (GO/GP) 82.83±11.34 80.37±11.28 0.908 0.366
At skin closure 85.23±12.21 82.11±12.1 1.072 0.287
After extubation 86.11±11.58 84.94±9.91 0.454 0.6507

Unpaired t test
The table-5 above and graph below compares the intraop HR between group P and O from preop
through after extubation. The differences of mean intraop heart rate between both groups were
found statistically non significant (P>0.05) at all time intervals.

TABLE 6: Comparison of Intraoperative SBP between group O and P from preop through after
extubation:
Intraoperative SBP(mmHg)
Time t value p value
Group O (Mean±SD) Group P (Mean±SD)
Preop 123.91±7.59 124.94±10.3 0.475 0.363
Pre induction 121.66±8.2 123.14±12.11 0.601 0.549
Post induction 120.23±7.94 120.86±11.0 0.274 0.784
Post intubation 119.83±7.87 121.26±9.76 0.674 0.502
At skin incision 120.74±6.14 122±10.69 0.603 0.548
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15min 122.11±6.26 122.14±10.12 0.041 0.988

30min 120.89±7.31 121.14±10.12 0.121 0.903
45min 121.74±8.35 120.23±11.73 0.622 0.535
60min 120.00±7.81 119.37±12.21 0.256 0.798
75min 119.63±5.17 118.74±10.43 0.45 0.654
90min 119.8±6.88 118.43±10.45 0.648 0.518
105min 120.91±6.05 118.46±9.86 1.256 0.213
120min 121.09±5.99 119.09±9.99 1.016 0.313
After giving drug (GO/GP) 120.03±5.57 121.37±9.49 0.722 0.472
At skin closure 120.29±6.5 121.46±9.76 0.59 0.556
After extubation 119.66±10.23 120.57±8.74 0.401 0.689

Unpaired t test
-The differences of mean intraop SBP between both groups were found statistically non significant
(P>0.05) at all time intervals.
TABLE 7: Comparison of Intraoperative DBP between group P and O from preop through after
extubation
Intraoperative DBP(mmHg)
Time t value p value
Group O (Mean±SD) Group P (Mean±SD)
Preop 78.06±7.84 78.17±8.13 0.059 0.952
Pre induction 77.14±7.39 76.83±7.99 0.170 0.864
Post induction 75.57±6.82 77.00±9.25 0.735 0.464
Post intubation 77.97±6.67 77.09±9.69 0.445 0.657
At skin incision 78.69±5.93 77.29±10.71 0.676 0.501
15min 77.37±4.94 76.14±8.63 0.771 0.467
30min 76.49±5.14 77.23±8.00 0.462 0.645
45min 75.63±5.47 76.66±9.13 0.571 0.569
60min 75.46±5.72 75.91±7.93 0.276 0.782
75min 74.94±4.43 73.51±7.56 0.964 0.338
90min 74.77±5.42 77.17±7.88 1.485 0.142
105min 75.26±4.56 76.74±7.5 1.001 0.320
120min 77.83±5.03 78.11±8.48 0.171 0.864
After giving drug (GO/GP) 81.4±6.1 80.66±13.87 0.290 0.772
At skin closure 80.43±8.17 81.17±7.75 0.390 0.697
After extubation 76.89±6.09 77.54±8.29 0.378 0.706

Unpaired t test
-The differences of mean intraop DBP between both groups were found statistically non significant
(P>0.05) at all time intervals.

TABLE 8: Comparison of Intraoperative MBP between group P and O from preoperative through
after extubation-
Intraoperative MBP(mmHg)
Time t value p value
Group O (Mean±SD) Group P (Mean±SD)
Preop 93.34±6.74 93.76±8.06 0.177 0.86
Pre induction 90.65±5.83 92.27±8.08 1.042 0.300
Post induction 90.46±5.61 91.62±7.6 0.695 0.488
Post intubation 91.98±5.1 91.81±7.88 0.144 0.885
At skin incision 92.7±4.45 92.19±8.08 0.273 0.785
15min 92.29±3.87 91.48±7.31 0.553 0.582
30min 90.62±4.08 91.87±6.98 0.925 0.358
45min 91.00±5.31 91.18±8.22 0.103 0.917
60min 90.3±5.28 90.4±7.6 0.036 0.971
75min 89.95±3.72 88.59±6.65 1.012 0.315
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90min 89.97±4.76 90.92±7.27 0.6408 0.523

105min 90.48±3.59 90.65±6.34 0.163 0.870
120min 90.91±3.91 91.77±6.88 0.642 0.522
After giving drug (GO/GP) 94.28±4.3 94.23±10.23 0.030 0.975
At skin closure 93.71±6.24 94.6±5.7 0.602 0.549
After extubation 90.48±5.52 91.89±5.32 1.054 0.295

Unpaired t test
-The differences of mean intraop DBP between both groups were found statistically non significant
(P>0.05) at all time intervals.

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TABLE 9: Comparison of Intraoperative Spo2% between group P and O from preop through post
extubation
Intraoperative SpO2%
Time t value p value
Group O (Mean±SD) Group P (Mean±SD)
Preop 99.03±0.66 98.83±0.75 1.184 0.24
Pre induction 99.2±0.72 99±0.77 1.125 0.264
Post induction 99.34±0.73 99.26±0.66 0.518 0.606
Post intubation 99.31±0.63 99.29±0.67 0.184 0.854
At skin incision 99.09±0.78 99.14±0.81 0.3005 0.764
15min 99.17±1.01 99±0.73 0.812 0.419
30min 99.54±0.51 99.37±0.73 1.141 0.257
45min 99.4±0.55 99.49±0.61 0.614 0.54
60min 99.31±0.63 99.6±0.60 1.935 0.057
75min 99.63±0.49 99.71±0.57 0.672 0.503
90min 99.6±0.55 99.77±0.55 1.304 0.196
105min 99.23±0.73 99.51±0.74 1.622 0.109
120min 99.22±0.77 99.54±0.7 1.786 0.078
After giving drug (GO/GP) 99.43±0.61 99.51±0.66 0.565 0.573
At skin closure 99.25±0.70 99.49±0.61 1.453 0.150
After extubation 99.54±0.51 99.69±0.53 1.154 0.252

Unpaired t test
-The differences of mean intraop SPO2 between both groups were found statistically non significant
(P>0.05) at all-time intervals.

TABLE 10: Comparison of Postoperative HR between group O and P from zero through 24 hr
postoperatively
Postoperative Heart Rate (bpm)
Time t value p value
Group O (Mean±SD) Group P (Mean±SD)
0 hr 81.94±11.71 79.74±12.79 0.750 0.455
30 min 82.46±10.63 81±11.89 0.540 0.590
60 min 82.23±10.21 79.46±11.2 1.082 0.2831
02 hrs 81.77±8.73 78.63±11.28 1.304 0.1967
04 hrs 84.23±8.74 82.26±10.67 0.845 0.4008
06 hrs 79.31±9.53 78.26±10.01 0.452 0.652
12 hrs 79.77±9.84 78.89±8.36 0.405 0.686
18 hrs 80±8.96 78±7.72 1.000 0.320
24 hrs 80.63±8.63 78.51±5.79 1.203 0.233

Unpaired t test
The table-10 above and graph below compares the postop HR between group P and O from zero
through 24 hr. The differences of mean postop HR between both groups were found statistically non
significant (P>0.05) at all time intervals.

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TABLE 11: Comparison of postoperative SBP between group O and P from zero through 24 hr
postoperatively
Postoperative SBP (mmHg)
Time t value p value
Group O (Mean±SD) Group P (Mean±SD)
0 hr 121.03±9.28 122.34±7.83 0.64 0.523
30 min 123.43±5.5 121.8±8.2 0.976 0.332
60 min 126.46±7.58 124.14±7.83 1.256 0.213
02 hrs 125.11±7.9 121.74±8.73 1.694 0.094
04 hrs 119.4±5.15 119.97±7.2 0.382 0.703
06 hrs 118.94±6.66 119.11±9.03 0.09 0.928
12 hrs 120.09±5.6 121.14±5.19 0.819 0.415
18 hrs 120.63±4.74 119.91±4.59 0.6403 0.524
24 hrs 120.37±3.21 118.8±3.56 1.939 0.056

Unpaired t test
-The differences of mean postop SBP between both groups were found statistically non significant
(P>0.05) at all-time intervals.

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TABLE 12: Comparison of Postoperative DBP between group O and P from zero through 24 hr
postoperatively
Postoperative DBP(mmHg)
Time t value p value
Group O (Mean±SD) Group P (Mean±SD)
0 hr 80.09±6.83 80±7.65 0.049 0.96
30 min 78.97±5.94 78.83±7.59 0.087 0.9304
60 min 77.71±4.82 78.71±7.52 0.661 0.5103
02 hrs 75.6±5.19 75.86±7.59 0.165 0.869
04 hrs 78.09±7.7 77.49±7.92 0.321 0.748
06 hrs 76.54±7.8 76.71±7.52 0.093 0.925
12 hrs 76.17±5.92 76.14±7.33 0.0179 0.985
18 hrs 78.2±4.22 78.37±6.35 0.133 0.894
24 hrs 79.86±4.47 79.31±5.85 0.436 0.664

Unpaired t test
- The differences of mean postop DBP between both groups were found statistically non significant
(P>0.05) at all time intervals.

TABLE 13: Comparison of POSTOPERATIVE MBP between group O and P from ZERO through
24 hr
Postoperative MBP(mmHg)
Time t value p value
Group O (Mean±SD) Group P (Mean±SD)
0 hr 93.73±5.55 94.11±5.63 0.254 0.799
30 min 93.79±5.02 93.15±5.05 0.545 0.587
60 min 93.96±3.83 93.86±5.13 0.105 0.916
02 hrs 92.1±3.86 91.15±4.47 0.881 0.381
04 hrs 91.86±5.97 91.65±5.08 0.129 0.897
06 hrs 90.68±5.86 90.85±6.29 0.118 0.906
12 hrs 90.81±4.79 91.14±5.69 0.250 0.803
18 hrs 92.34±4.04 92.1±4.95 0.132 0.895
24 hrs 93.36±3.89 92.48±4.19 1.003 0.319

Unpaired t test
-The differences of mean postop MBP between both groups were found statistically non significant
(P>0.05) at all time intervals.

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TABLE 14: Comparison of postoperative SPO2 between group P and O from zero through 24 hr
Postoperative SpO2%
Time t value p value
Group O (Mean±SD) Group P (Mean±SD)
0 hr 99.49±0.51 99.2±0.72 1.92 0.059
30 min 99.6±0.55 99.31±0.76 1.801 0.076
60 min 99.57±0.5 99.49±0.7 0.5877 0.558
02 hrs 99.37±0.54 99.43±0.7 0.381 0.704
04 hrs 99.45±0.50 99.63±0.6 1.295 0.199
06 hrs 99.4±0.49 99.57±0.56 1.358 0.179
12 hrs 99.54±0.51 99.71±0.46 1.486 0.141
18 hrs 99.65±0.48 99.77±0.49 0.983 0.328
24 hrs 99.8±0.40 99.89±0.32 0.977 0.331

Unpaired t test
-The differences of mean postop SPO2 between both groups were found statistically non significant
(P>0.05) at all time intervals.

TABLE 15: Comparison in Time to extubation after reversal (min) between groups O AND P
Time to extubation Group O Group P
after reversal (min) N % N %
12-14 20 57.14 16 45.71
15-17 15 42.86 17 48.57
≥18 0 0.00 2 5.71
Median 14 15
Range 12-16 12-18
Mean±SD 14.31±1.15 14.6±2.00
t & p value 0.730, 0.467

Unpaired t test
Among all enrolled patients, the, 20 patients in Group O and 16 patients in group P were found in
category 12- 14 mint. In 15-17minute category, group O had 15 patients and group P had 17
patients. In > or equal to 18minutes category, group O had zero patients and group P had 2 patients.
Among all enrolled patients, the mean extubation time was found 14.31±1.15 in group O and
14.6±2.00 in group P. The difference between the mean time to extubation of both groups was found
as statistically non- significant (P >0.05)
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TABLE 16: Comparison in Time Interval between extubation and first dose antiemetic (hr) between
group O and P
Time interval between extubation Group O Group P
and first dose antiemetic (hrs) N % N %
≤5 0 0.00 13 37.14
5.1-6 5 14.29 22 62.86
6.1-7 16 45.71 0 0.00
>7 14 40.00 0 0.00
Median 7 5.5
Range 6-9 5-6
Mean±SD 7.18±0.76 5.55±0.52
IQR (Q1-Q3) 1 (5-6) 1.25(6.75-8)
t & p value 10.35, <0.0001

Unpaired t test
Among all enrolled patients, in group O, none of the patients required rescue antiemetic in less than
5 hr category, 5 patients demanded rescue antiemetic in 5.1-6 hr category, 16 patients demanded
antiemetic in 6.1 to 7 hr category and 14 patients demanded in >7 hr category. In group P, 13
patients demanded in </= 5 hr category, 22 patients demanded in 5.1 -6 hr category, no patients
demanded antiemetic in 6.1-7 hr and >7hr category. Among all enrolled patients, 45.71% belonged
to 6.1-7 hr category in group O while 62.86% patients belonged to 5.1 – 6 hr category in group P.
Among all enrolled patients the mean time was found as 7.18±0.76 hour in group O while 5.55±0.52
hour in group P. The difference between the mean time interval between extubation and first dose
antiemetic of both groups was found as statistically significant (P<0.0001).

TABLE 17: Comparison in Time to stay in PACU after extubation (min) between group O and P
Time to stay PACU Group O Group P
after extubation (min) N % N %
60-75 7 20.00 7 20.00
76-90 20 57.14 25 71.43
≥91 8 22.86 3 8.57
Median 85 82
Range 60-98 62-96
Mean±SD 83.91±9.22 81.45±7.29
t & p value 1.236, 0.220

Unpaired t test
-Among all enrolled patients, in Group O, 7 patients stayed in PACU in 60-75 minutes category, 20
patients stayed in PACU in 76-90 minutes category, 8 patients stayed in >/= 91 minutes category.
While in group P, 7 patients stayed in PACU in 60-75 minutes category, 25 patients stayed in PACU
in 76-90 minutes category, 3 patients stayed in >/= 91 minutes category. Among all enrolled
patients, in 76-90 minutes category, 57.14% belonged in group O while 71.43% belonged in group
P. Among all enrolled patients, the mean time to stay in PACU was found as 83.91±9.22 minutes in
group O while 81.45±7.29 minutes in group P. The difference between mean Time to stay in
PACU after extubation (min) of both groups was found as statistically Non - significant (P
value>0.05).

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TABLE 18: Comparison for total frequency of rescue antiemetic used in 24 hr between group O
and P
Group O Group P
Total frequency of rescue antiemetic used in 24hrs Postop
N % N %
One 17 48.57 16 45.71
Two 16 45.71 15 42.86
Three 2 5.71 4 11.43
Total 35 100.00 35 100.00
Mean±SD 1.57±0.60 1.65±0.68

-Among all enrolled patients, in Group O , 17 patients required one time rescue antiemetic , 16
patients required two times rescue antiemetic , 2 patients required 3 times rescue antiemetic. While
in group P, 16 patient’s required one time rescue antiemetic, 15 patients required two times rescue
antiemetic, 4 patients required 3 times rescue antiemetic. Among all enrolled patients, mean of total
frequency of rescue antiemetic required in 24 hours postop was 1.57±0.60 in group O and 1.65±0.68
in group P, so, mean of total frequency of rescue antiemetic used in 24 hr was found as
statistically Non - significant (P Value (>0.05).

TABLE 19: Comparison of complications between group O and P

Group O Group P
Complications P value
N % N %
Hypotension 2 5.71 2 5.71 1.000
Bradycardia 0 0.00 0 0.00 -
Allergy 0 0.00 0 0.00 -

The table-19 compares the complications between both groups. The difference in number of
complications between both groups was found to be statistically non-significant (P>0.05).

TABLE 20: Comparison of PONV score between group O and P

PONV Score z score p value
Time Group O Group P
M Mean±Sd M Mean±Sd
0hr 0 0.49±0.51 1 0.6±0.5 -0.946 0.343
30min 1 1.37±0.49 1 1.34±0.48 0.246 0.805
60min 2 1.63±0.49 2 1.63±0.49 0.000 1.000
2hrs 2 2.43±0.5 2 2.46±0.51 -0.236 0.812
4hrs 3 2.91±0.45 5 4.54±0.51 -14.20 <0.0001
6hrs 4 4.06±0.24 3 3.29±0.71 6.098 <0.0001
12hrs 3 2.54±0.51 3 2.57±0.5 -0.236 0.812
18hrs 2 1.66±0.48 2 1.77±0.65 -0.838 0.401
24hrs 2 1.68±0.75 1 1.49±0.51 1.298 0.194

Z test
Time Group O Group P P value
0-6hr 2.147± 1.23 2.309±1.41 0.6119
12-24hr 2.22±0.626 1.94±0.71 0.111
overall 2.16±1.07 2.18±1.23 0.94

The table 20 above and graph 20 below shows comparison in PONV score between group O and
P.
The difference in mean PONV score of both groups was found as statistically non significant
(p>0.05) at most of time intervals except at 4 hr and 6 hr.

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The PONV at 4 hr in group O was 3 and in group P was 5, mean value 2.91±0.45in group O and
4.54±0.51 in group P, p value (<0.0001) found statistically significant
The PONV at 6 hr in group O was 4 and in group P was 3, mean value 4.06±0.24 in group O and
3.29±0.71 in group P, p value (<0.0001) found statistically significant
Overall, mean PONV score was found as 2.16±1.07 in group O and 2.18±1.23 in group P.
The difference of overall mean PONV score between both groups was found as statistically non-
significant (p>0.05).

DISCUSSION
The importance of motivating this research is focused on the high level of reported incidence of
postoperative nausea and vomiting. PONV is a common problem after abdominal surgery and can
lead to complications such as wound dehiscence, prolonged recovery stay, prolonged hospital stay,
and thus it increases cost.

Published articles show a great discrepancy in the incidence of PONV ranging from 30% to 70%
Together with the increased hospital costs and the fear towards this condition felt by patients, this
makes it a topic of special interest for anaesthetists. The impact of this research study is based on the
fact propofol which is the recently most commonly developed anaesthesia inducer by the
pharmaceutical industry and perhaps the most commonly used for general anaesthesia in the world
by anaesthetists, had been found to have antiemetic properties.

The results obtained in this randomised, prospective, double blind, comparative clinical trial
regarding the prophylactic PONV effect of ondansetron and propofol by measuring the mean of total
frequency of rescue antiemetic used in 24 hours postoperatively in abdominal surgeries suggest the
following:

AGE, SEX, ASA AND BMI -WISE DISTRIBUTION

There was even distribution of age in both groups. A random allocation of patients was done in both
groups. The mean age in Group D was 36.0±11.1 year while in Group P, mean age is 37.4±12.3
year. Similar age range have also been reported by Naghibi K et al (2015) (50) & L.A. Rosillo-
Meneses et al (2016) (52) & Hailu Yimer et al (2016)53 in their study.
In our study, out of 35 patients in each group, 12 female patients were in group O, 13 female
patients were in group P. The p value was >0.05 i.e. statistically insignificant. Our results were
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similar as studies conducted by Naghibi K et al (2015) (50) & L.A. Rosillo-Meneses et al (2016) (52)
& Hailu Yimer et al (2016)53

ASA grading- In our study, only patients with ASA physical status I and II were taken and no
significant difference (p >0.05) was observed between both groups. Our results were in line with the
studies done by Naghibi K et al (2015) (50) & various other studies.
In our study there was even distribution of BMI in both groups. The mean BMI in Group O is
22.47±2.03 (Kg/m2) and in Group P is 22.62±2.72 (Kg/m2). Mean BMI of both groups was
between 22-24 kg/m2. The variation in the distribution of the patients according to BMI was
statistically insignificant P value >0.05, which coincides with the study conducted by Naghibi K et
al (2015) (50) & L.A. Rosillo-Meneses et al (2016) (52) & Hailu Yimer et al (2016)53
Hence the demographic profile of both groups of our study was comparable (P>0.05). This provided
us the uniform platform to evenly compare the results obtained.

HEAMODYNAMIC CHANGES
There was no significant difference in the haemodynamic parameters i.e. HR, SBP, DBP, MBP &
SpO2 during (from preop through after extubation) & Postop (from zero through 24 hr) in both
groups. HR, SBP, DBP, MBP & SpO2 remained stable without any fluctuation.
Similar results of HR, SBP, DBP , MBP & SpO2 trends have also been reported by Naghibi K et al
(2015) (50) & L.A. Rosillo-Meneses et al (2016) (52) & Hailu Yimer et al (2016)53 in their studies.

RESCUE ANTIEMETIC
Time interval between extubation and first dose rescue antiemetic & mean of total frequency of
rescue antiemetic (metoclopramide 10 mg ) required in 24 hours postop was recorded in group
O & P.
48.57% patients required one time MCP in 24 hr , 45.71% patients required 2 time MCP in 24 hr,
5.71% required MCP 3 times in 24 hr ,in group O, while 45.71% patients required one time MCP in
24 hr , 42.86% patients required 2 time MCP in 24 hr, 11.43% required MCP 3 times in 24 hr, in
group P. Mean value of Total frequency of rescue antiemetic in 24 hr is comparable in both
groups O and P, 1.57+/-0.60 & 1.65+/-0.68 respectively and not significant statistically (p value
> 0.05). Our results were in line with the studies done by Naghibi K et al (2015) (50)
In our study we observed that, time interval between extubation and first dose rescue antiemetic
was statistically significant between Group O and group P (p value <0.0001).
In group O , 14.29 % patients required MCP between 5.1 to 6 hr category , 45.71 % patients
required MCP in 6.1 to 7 hr category and 40 % patients required MCP in >7 hr category . 7.18±0.76
hr is mean time between extubation and first dose of antiemetic requirement in group O.
While in group P, 37.14 % patients required MCP <5 hr category, 62.86 % patients required MCP in
5.1 to 6 hr category. 5.55±0.52 hr is mean time between extubation and first dose of antiemetic
requirement in group P.
The difference in mean time interval between extubation and first dose rescue antiemetic
between group O and group P was found as statistically significant ( p<0.0001)

Incidence & Severity of Nausea & Vomiting (PONV SCORE & VNRS SCALE55)
PONV was defined as at least one episode of either nausea or vomiting or both during the first 24 h
postoperatively. We recorded incidence of nausea and vomiting at 0 hr, 30 mint, 1 hr, 2 hr, 4 hr, 6hr,
12hr, 18hr, and 24hr postoperatively.
In our study we observed that at time 4hr & 6 hr significant results P< 0.05 obtained when PONV &
VNRS scoring was done. Mean values are as follows:-

VNRS
At 4 hr, Grp O showed 4.60±0.65 and Grp P showed 6.37±0.49
At 6 hr, Grp O showed 6.14±0.77 and Grp P showed 5.42±0.72

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PONV
At 4 hr, Grp O showed 2.91±0.45 and Grp P showed 4.54±0.51
At 6 hr, Grp O showed 4.06±0.24 and Grp P showed 3.29±0.71.
P value at 4 hr and 6 hr was statistically significant (<0.0001) in group P and O which showed
patients in propofol group had early demand of rescue antiemetic than ondansetron group’s patients
in 0-6 hr postop period which is in concordance with by Naghibi K et al (2015) (50) & L.A. Rosillo-
Meneses et al (2016) (52) & Hailu Yimer et al (2016)53 in their studies.

Our results showed that there were no significant differences among requirement of rescue
antiemetic in both groups at 12 to 24 hr postoperatively. Regarding the number of patients that need
rescue anti-emetics, our result was also comparable with other studies. These results are similar to
those reported by previous studies [56, 57] although, of note, the assessment tool used and definition
of severity of nausea differs between studies.

The protection exercised by ondansetron to prevent postoperative nausea and vomiting showed no
statistically significant difference with respect to propofol, in line with the study published by
Kalidag et al. (57) .They found an identical decrease in nausea and vomiting between propofol and
ondansetron (71.4%). Splinter et al. (58) found a similar efficacy even though their sample was
from among the paediatric population.

PACU STAY
Mean time to stay in PACU after discharge from recovery room was found to be 83.91 ±9.22
minutes in group O and 81.45±7.29 in group P , which is in line with results obtained by Naghibi K
et al (2015) (50) which were 75±6 minutes in group 30 mg propofol and 95±15 minutes in group
MCP .

TIME FOR EXTUBATION AFTER REVERSAL

The mean time for extubation after reversal (minutes) was found as 14.31+/-1.15 in group O and
14.6+/-2.00 in group P. Our results are not significant statistically.

COMPLICATIONS
The difference in the incidence of complications in group O & P were statistically insignificant. The
adverse events reported were those that would be expected in patients having surgery performed
under general anaesthesia.
Gann TG and colleagues 56 reported that the plasma concentration of propofol to have antiemetic
property was much lower when compared to the concentration associated with sedation (343 ng/ml
and 1 to 3 mcg/ml, respectively). Our finding was in line with this study in which there were no
significant documented complications such as hypotension, apnoea and a decrease in oxygen
saturation in the propofol group. We are using small dose of propofol (30 mg), this dose has been
used in Naghibi K et al (2015) (50) & L.A. Rosillo-Meneses et al (2016) (52) & Hailu Yimer et al
(2016)53 in their studies with the effect of reducing PONV without any complications. The overall
side effect profile was similar in both groups of our present study.

CONCLUSION
From this study it can be concluded that subhypnotic dose of Propofol at end of surgery is
comparable to standard antiemetic ondansetron (5HT3 Antagonist) as conventional therapy for
preventing PONV in patients undergoing general anaesthesia for abdominal Surgery in terms of
nausea, vomiting and requirement of rescue antiemetic. Use of propofol as an induction agent in
abdominal surgery protects the patient from nausea and vomiting in the early post-operative period
(0-6hours), but after 6 hours, the incidence of nausea and vomiting reaches the same value of any
technique which does not use propofol.

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