Q: 44 year old female is admitted to ICU with hypovolemia after chemotherapy session and continue to have severe nausea and bouts of vomitting. All conventional anti emetics failed to control her symptoms. Can you use propofol as anti emetic without getting patient intubate?



Answer: Yes

Propofol has a good antiemetic effect at low dose (subhypnotic dose) when other anti emetics fail in severe nausea and vomitting after surgey or chemotherapy sessions. It can be given as a continuous infusion of 1 mg /kg/hr or as single dose of 10 mg(1 cc) which provides relief for about 30 minutes. Propofol acts directly on the chemoreceptor trigger zone, vagal nuclei, and other centers implicated in nausea and vomiting.



References:

1. Subhypnotic doses of propofol possess direct antiemetic properties. Anesth Analg. 1992 Apr;74(4):539-41.

2. When Nothing Helps: Propofol as Sedative and Antiemetic in Palliative Cancer Care - Journal of Pain and Symptom Management Volume 30, Issue 6, December 2005, Pages 570-577

3. Prevention of postoperative nausea and vomiting by continuous infusion of subhypnotic propofol in female patients receiving intravenous patient‐controlled analgesia - Br. J. Anaesth. (2000) 85 (6): 898-900.