Propofol is known to possess direct antiemetic effects. Propofol antiemetic use for induction and maintenance of anaesthesia has been shown to be associated with a lower incidence of postoperative nausea and vomiting (PONV) when compared to any other anaesthetic drug or technique.
It has been shown that total intravenous anaesthesia (TIVA) with propofol for anaesthesia is associated with less PONV than volatile agents, but that it reduced only early PONy. A subhypnotic dose (1.0 mg/kg/h) of propofol antiemetic in continuous infusion can be effective for preventing nausea and vomiting.
TIVA with propofol with or without remifentanil has been shown to be very useful for reducing the high incidence of PONV after squint surgery in children. However, although performing a TIVA with propofol is a reasonable prophylactic approach, but it does not solve the problem satisfactorily alone if the risk is very high.
Combining propofol with another antiemetic such as serotonin antagonist, dexamethasone or droperidol, is probably the best approach. Subhypnotic doses of propofol (10 to 15 mg IV) may be used in the postanaesthesia care unit to treat nausea and vomiting, particularly if it is not of vagal origin.
In the postoperative period, the advantage of propofol antiemetic is its rapid onset of action and the absence of serious side effects. When used as an adjuvant propofol in subhypnotic doses is effective against chemotherapy-induced nausea and vomiting.
The mechanism of action in this context is still not well understood. Propofol antiemetic is generally efficacious in treating postoperative nausea and vomiting at plasma concentrations that do not produce increased sedation.
The properties of propofol antiemetic at subhypnotic doses are not mediated via interactions with the dopaminergic system.
It is possible that propofol antiemetic modulates subcortical pathways to inhibit nausea and vomiting or produces direct depressant effect on the vomiting center. Subhypnotic doses of propofol dose not show any prokinetic action.