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Propofol infusion vs thiopentone/isoflurane anaesthesia for prominent ear correction in children
Abstract
Postoperative nausea and vomiting (PONV) frequently follows prominent ear correction under general anaesthesia in children. In a prospective, single-blind study, we compared the incidence of PONV after propofol infusion anaesthesia with that following thiopentone induction and isoflurane maintenance in 30 children aged from four to 14 years randomly allocated to one of two groups. All the children were mechanically ventilated. Anaesthesia was supplemented in both groups with nitrous oxide and infiltration of the ears using a mixture of bupivacaine, adrenaline, and hyaluronidase. One child receiving propofol (group P) complained of nausea, compared with eight receiving thiopentone/ isoflurane, (group T) (P = 0.005), while three children in group P and ten in group T vomited before hospital discharge, (P = 0.01). Eight children in group P were considered to be fit for discharge on the day of surgery as against four in group T, (not significant). Only four out of twelve children receiving opioid analgesia vomited.
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Transdermal hyoscine patches and maintenance anesthesia with propofol each reduced vomiting rates by about one-half relative to placebo or thiopentone/isoflurane, respectively.
“Transdermal hyoscine patches18 and maintenance anesthesia with propofol19 each reduced vomiting rates by about one-half relative to placebo or thiopentone/isoflurane, respectively.”
From Perioperative Analgesia and Postoperative Nausea and Vomiting Management in Otoplasty: A Systematic Review (2026) · cites this paper as [19]
Propofol accelerated recovery: mean time to eye-opening was 6.3 minutes compared with 11.7 minutes in controls.
“Propofol also accelerated recovery: mean time to eye-opening was 6.3 minutes compared with 11.7 minutes in controls.19”
From Perioperative Analgesia and Postoperative Nausea and Vomiting Management in Otoplasty: A Systematic Review (2026) · cites this paper as [19]
Where duration was reported, a single regional nerve block injection provided 8 hours or more of analgesia.
“Where duration was reported, a single RNB injection provided 8 hours or more of analgesia1,7; subsequent oral or parenteral drugs were administered only as needed.1,7,19”
From Perioperative Analgesia and Postoperative Nausea and Vomiting Management in Otoplasty: A Systematic Review (2026) · cites this paper as [19]
Same-day discharge was more frequent when propofol, regional nerve block, or local anesthetic with sedation formed part of the regimen, whereas overnight observation was usual after conventional inhalational anesthesia or exclusive reliance on local infiltration anesthesia.
“Same-day discharge was more frequent when propofol, RNB, or local anesthetic with sedation formed part of the regimen,1,19,21 whereas overnight observation was usual after conventional inhalational anesthesia or exclusive reliance on LIA.7,15,17”
From Perioperative Analgesia and Postoperative Nausea and Vomiting Management in Otoplasty: A Systematic Review (2026) · cites this paper as [19]
Woodward et al reported that propofol maintenance anesthesia produced only 1 episode of nausea and 3 of vomiting, versus 8 and 10, respectively, after thiopentone/isoflurane.
“Likewise, Woodward et al19 reported that propofol maintenance anesthesia produced only 1 episode of nausea and 3 of vomiting, versus 8 and 10, respectively, after thiopentone/isoflurane.”
From Perioperative Analgesia and Postoperative Nausea and Vomiting Management in Otoplasty: A Systematic Review (2026) · cites this paper as [19]
No irreversible neurovascular or infectious events were documented after more than 200 regional blocks.
“Hyoscine’s anticholinergic sequelae (blurred vision, dizziness, transient bradycardia) were short-lived, and no irreversible neurovascular or infectious events were documented after more than 200 regional blocks, underscoring the favorable safety profile of both strategies.19,26”
From Perioperative Analgesia and Postoperative Nausea and Vomiting Management in Otoplasty: A Systematic Review (2026) · cites this paper as [19]
Propofol reduced both PONV incidence and emergence time relative to thiopentone/isoflurane.
“Propofol reduced both PONV incidence and emergence time relative to thiopentone/isoflurane but requires infusion pumps and vigilant hemodynamic monitoring, factors that may limit use in low-resource settings.4,19”
From Perioperative Analgesia and Postoperative Nausea and Vomiting Management in Otoplasty: A Systematic Review (2026) · cites this paper as [19]
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Postoperative nausea and vomiting in paediatric patients
Rose, J. B., & Watcha, M. F. (1999) · British Journal of Anaesthesia · doi:10.1093/bja/83.1.104 · Cited by 230
Management of Postoperative Nausea and Vomiting in Children
Kovac, A. L. (2007) · Pediatric Drugs · doi:10.2165/00148581-200709010-00005 · Cited by 126
“7 Magnetic Resonance Imaging Woodward et al.[159] evaluated the effectiveness of a propofol A retrospective review[15] evaluated 234 consecutive cases of infusion versus a thiopental/isoflurane anesthesia technique for POV in children undergoing anesthesia for magnetic resonance prominent ear correction surgery.”
BackgroundIntravenous versus inhalational anaesthesia for paediatric outpatient surgery
Ortiz, A. C., Atallah, Á. N., Matos, D., & da Silva, E. M. (2014) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd009015.pub2 · Cited by 64
Pharmacokinetics and Pharmacology of Drugs Used in Children
Coté, C. J., Lerman, J., Ward, R. M., Lugo, R. A., & Goudsouzian, N. G. (2009) · Elsevier eBooks · doi:10.1016/b978-141603134-5.50010-x · Cited by 40
Pharmacokinetics and Pharmacology of Drugs Used in Children
Anderson, B. J., Lerman, J., & Coté, C. J. (2019) · Elsevier eBooks · doi:10.1016/b978-0-323-42974-0.00007-0 · Cited by 21
Postoperative nausea and vomiting in children
Munro, H. M. (2000) · Journal of PeriAnesthesia Nursing · doi:10.1053/jpan.2000.19470 · Cited by 12
Newer Drugs in Pediatric Anesthesia
Everett, L. L. (1999) · Seminars in Pediatric Surgery · doi:10.1016/s1055-8586(99)70002-8 · Cited by 9
Plastic and Reconstructive Surgery
Stricker, P. A., Fiadjoe, J. E., & Lerman, J. (2019) · Elsevier eBooks · doi:10.1016/b978-0-323-42974-0.00035-5 · Cited by 8
Anaesthesia for plastic surgery in children
Fenlon, S. (2002) · Current Anaesthesia and Critical Care · doi:10.1054/cacc.2002.0384 · Cited by 6
Sarti, A., Busoni, P., Dell’Oste, C., et al. (2004) · Pediatric Anesthesia · doi:10.1046/j.1460-9592.2003.01170.x · Cited by 4
Plastic and Reconstructive Surgery
Engelhardt, T., Crawford, M. W., & Lerman, J. (2009) · Elsevier eBooks · doi:10.1016/b978-141603134-5.50037-8 · Cited by 2
Alnufaei, A. H., AlSubaie, F. K., Aljabri, R. A., Aloqayli, S. Z., Alanshmi, S., Alotaibi, S. M., Ajeeb, Z. B., AlGhamdi, L. Y., Kattan, M. E., Alahmadi, B. H., et al. (2026) · Plastic and Reconstructive Surgery - Global Open · doi:10.1097/gox.0000000000007347
“19,26”
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Metadata
- Authors
- WOODWARD, W. M., BARKER, I., JOHN, R. E., & PEACOCK, J. E.
- Affiliations
- Sheffield Children's Hospital (GB)
- Venue
- Pediatric Anesthesia
- Publisher
- Wiley
- Published
- 1997-09
- Volume
- 7
- Issue
- 5
- Pages
- 379-383
- ISSN
- 1155-5645 (ISSN-L)
- 1460-9592
- OpenAlex
- W2041257409
- Cited by
- 12
- References
- 0
- Citations by year
- 2026: 1 · 2019: 2 · 2014: 1
- FWCI
- 1.15
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Pediatric Anesthesia (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Nausea and vomiting management
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Sedative Agents
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Pain Management
- Keywords
- thiopental, isoflurane, postoperative nausea and vomiting, otoplasty, pediatric anesthesia, opioid analgesia, discharge readiness, bupivacaine infiltration
- MeSH terms
- Adolescent, Anesthesia Recovery Period, Anesthesia, General, Child, Child, Preschool, Ear, External, Humans, Isoflurane, Nausea, Postoperative Pain, Prospective Studies, Thiopental, Vomiting, Propofol, Single-Blind Method, Anesthetics, Inhalation, Anesthetics, Intravenous, Anesthetics, Combined
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