Anesth Analg 2003;97:1545
© 2003 International Anesthesia Research Society
LETTERS TO THE EDITOR
Subhypnotic Dose of Droperidol May Increase Frequency of PONV After Propofol Anesthesia
Yushi U. Adachi, MD PhD,
Maiko Satomoto, MD,
Hideyuki Higuchi, MD PhD, and
Kazuhiko Watanabe, MD PhD
Medical Clinic of Kumagaya Base, Japan Air Self Defense Force
Medical Corps, Air Base Group, 1st Air Wing, Japan Air Self Defense Force
Department of Anesthesia, Japan Self Defense Force Hanshin Hospital
Department of Anesthesia, Shiki Citizen Hospital, Shiki City, Saitama, Japan
To the Editor:
We read with great interest the article by Nakayama et al. (1), in which they clearly demonstrated the effect of additional droperidol on the value of bispectral index during propofol sedation. We previously reported that 20 µg · kg-1 of droperidol reduced hypnotic dose of propofol during induction of anesthesia, however, the change in the level of hypnosis was not evaluated (2). In the current investigation, enhancement of droperidol on the hypnotic effect of propofol in a dose-dependent manner was described (1).
Although their results were really explicit, another interaction concerning the antiemetic action has room for discussion. Despite of enhancement of the hypnotic effect, 1 mg of droperidol failed to reduce the incidence of postoperative nausea and vomiting (PONV) (1). Both droperidol and propofol show antiemetic action. However, subhypnotic dose of droperidol may increase the frequency of PONV after propofol anesthesia (3). Thus, additional administration of droperidol to propofol anesthesia for prophylaxis of PONV might be controversial. One of possible explanations for the results of Nakayama et al. (1) is that 1 mg droperidol antagonize the antiemetic effect of propofol, whereas, 2 mg droperidol might be enough to avoid PONV in spite of the offset by small dose. As the authors discussed that the size of the study was too small, further investigation is required to clarify the biphasic interaction between droperidol and propofol.
Footnotes
Dr. Nakayama did not respond.
References
- Nakayama M, Kanaya N, Ichinose H, et al. Intravenous droperidol causes a reduction in the Bispectral Index in propofol-sedated patients during spinal anesthesia. Anesth Analg 2003; 96: 765–8.[Abstract/Free Full Text]
- Adachi YU, Uchihashi K, Watanabe K, Satoh T. Small dose midazolam or droperidol reduces the hypnotic dose of propofol at the induction of anaesthesia. Eur J Anaesthesiol 2000; 17: 126–31.[Web of Science][Medline]
- Wagner BK, Berman SL, Devitt PA, O’Hara DA. Retrospective analysis of postoperative nausea and vomiting to determine antiemetic activity of droperidol added to propofol: a possible drug interaction. Pharmacotherapy 1994; 14: 586–91.[Medline]
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