Total Intravenous Anesthesia (TIVA) Versus Inhalational Anesthesia at The End of Laparoscopic Obstetric Surgery Regarding Postoperative Nausea and Vomiting

Assiut University

Status: Not yet enrolling

Conditions: Laparoscopic Obstetric Surgery

Treatments: Procedure: inhalational anaesthesia; Procedure: total intravenous anesthesia (TIVA)

Study type: Interventional

Funder types: Other

Identifiers

NCT07270289

tiva vs inhala anesth in ponv

Details and patient eligibility

About

Postoperative nausea and vomiting (PONV) remain among the most common and distressing complications after general anaesthesia, with important consequences for patient comfort, satisfaction, recovery trajectories, and length of stay following surgery. The incidence of PONV is especially high after laparoscopic and gynaecological procedures due to patient- and procedure-related risk factors, making effective prevention and management a priority in perioperative care [5,8].

Anaesthetic technique is a recognized, modifiable determinant of PONV. Numerous clinical trials and randomized studies have demonstrated that the choice between propofol-based total intravenous anaesthesia (TIVA) and volatile inhalational maintenance can materially influence PONV incidence. Propofol-based TIVA has been repeatedly associated with lower rates of early and overall PONV compared with volatile agents in diverse surgical populations, supporting its role as an antiemetic strategy in addition to pharmacologic prophylaxis [1,2,4,9].

Trials specifically conducted in gynaecological and laparoscopic surgical populations report consistent reductions in nausea and vomiting with propofol maintenance compared with isoflurane or other volatile agents. These procedure-specific data are directly relevant to studies in gynecological laparoscopy, where baseline PONV risk is elevated and where anesthetic technique may yield a clinically meaningful reduction in patient morbidity [5,8,9].

Meta-analyses and systematic reviews pooling randomized controlled trials provide higher-level evidence that TIVA reduces the relative risk of PONV compared with volatile anaesthesia. Trial-sequential and pooled analyses estimate a clinically important risk reduction favoring TIVA, although effect sizes vary with study populations, prophylactic antiemetic regimens, and outcome time windows; these syntheses underpin the rationale for a targeted randomized comparison in the gynecological laparoscopic setting [2,4,10].

Enrollment: 98 estimated patients

Sex: Female

Ages: 18 to 50 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Female, age 18-50 years.
• Elective laparoscopic procedure under general anaesthesia with endotracheal intubation.
• Expected surgical duration ≥ 30 minutes. -.Ability to consent and complete questionnaires

Exclusion criteria

• Pregnancy or lactation.
• BMI ≥ 40 kg/m²; severe cardiopulmonary disease; hepatic/renal failure.
• History of malignant hyperthermia or contraindication to study drugs.
• Known allergy to propofol, , , sevoflurane/desflurane.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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98 participants in 2 patient groups

Group A

Active Comparator group

Description:

patients will be offed from inhalational anesthesia and Switched to propofol TIVA for the final 10 minutes of surgery

Treatment:

Procedure: total intravenous anesthesia (TIVA)

Procedure: inhalational anaesthesia

Group B

Active Comparator group

Description:

patients will be Continued on inhalational anaesthesia (sevoflurane or isoflurane per protocol)during the same final phase through extubation.

Treatment:

Procedure: inhalational anaesthesia