2 6
O U T P A T I E N T S U R G E R Y M A G A Z I N E O N L I N E | A U G U S T 2 0 1 5
Reduce PONV by "Bookending" Propofol
The key is to get gas out of the patient's system.
I
've developed an anesthetic technique that significantly reduces
PONV and costs, and improves patient, surgeon and nurse satis-
faction. I call it "bookending," because it involves using propofol
both at the beginning and at the end of a given procedure.
Most general anesthetics use gas for maintenance, but it's been
proven that propofol infusions without gas significantly reduce the
incidence of PONV. My technique uses gas, but transitions back to
propofol at the end of the procedure, after the gas is discontinued.
The idea comes from a 1996 study (osmag.net/JuY6Vd) that ostensibly
found that the technique doesn't work. I believe it does work, and I
think I know what was wrong with that initial study.
A N E S T H E S I A A L E R T
Michael Reines, MD
Jason
Meehan
z ENCORE Take advantage of propofol's antiemetic prop-
erties by reintroducing it toward the end of the procedure.
