Effects of Dexmedetomidine on Postoperative Nausea and Vomiting in Adult Patients Undergoing Ambulatory Thyroidectomy: A Randomized Clinical Trial

Abstract

Background: Postoperative nausea and vomiting (PONV) is a common and disturbing problem in patients undergoing ambulatory thyroidectomy. This prospective trial aimed to explore whether dexmedetomidine (DEX) combined with azasetron (AZA) can further drop the incidence of PONV in patients undergoing ambulatory thyroidectomy compared with AZA.Methods: This single-center, randomized, double-blind trial involved 172 adult patients undergoing ambulatory thyroidectomy. The individuals were randomized to DEX + AZA group and AZA group. In the DEX + AZA group, patients received dexmedetomidine 0.5 μg kg−1 for 10 min and then the infusion rate was held at 0.1 μg kg−1 h−1 until the completion of the operation, while the same amount of 0.9% saline in the AZA group. At the completion of the surgery, 10 mg azasetron was administered to every patient in both groups. The primary outcome was the incidence of 24 h PONV after ambulatory thyroidectomy. The secondary outcomes included residence time in recovery room, pain scores, severity of nausea, and adverse events.Results: No significant difference was found in the incidence of 24-h PONV between the DEX + AZA group and the AZA group [36% (30 of 84) vs. 38% (32 of 84); relative risk, 0.94; 95% confidence interval (CI), 0.63–1.40; P = 0.749]. The incidence of severe nausea was similar between the DEX + AZA group and the AZA group [57% (12 of 21) vs. 43% (9 of 21); relative risk, 1.33; 95% CI, 0.72–2.50; P = 0.355].Conclusions: Intraoperative dexmedetomidine combined with azasetron failed to drop the incidence of 24-h PONV compared with azasetron alone in patients undergoing ambulatory thyroidectomy.

Beneficial Effects of Low-Dose Intravenous Dexmedetomidine Premedication in Patient Undergoing Laparoscopic Cholecystectomy Under General Anesthesia: A Prospective, Double-Blind, Randomized Controlled Trial

“…Possible mechanism may be related to the inhibitory effect of Dex on sympathetic nerve activity, reduction in plasma catecholamine concentrations. 35 Additionally, as an adjuvant for general anesthesia, Dex can significantly reduce anesthetic consumption, which is another important factor in reducing the incidence of nausea and vomiting. Agitation during postoperative recovery is a common complication of general anesthesia.…”

The safety, benefits and future development of overnight and outpatient thyroidectomy

“…Studies have shown that moderate use of dexmedetomidine in thyroidectomy can reduce the use of postoperative anesthesia, which will help patients’ postoperative analgesia ( 22 , 23 ). However, the use of dexmedetomidine during overnight thyroidectomy did not reduce the incidence of PONV at 24 hours in postoperation (p=0.355) ( 24 ). To reduce the incidence of the postoperative POVN, intraoperative cervical plexus anesthesia block, rational use of anesthetic drugs in preoperative multimodality, postoperative use of non-steroidal drugs such as Acetaminophen or Ibuprofen in combination with appropriate Opioid analgesia has a good effect on preventing postoperative POVN, which can also indirectly reduce the dosage of opioids ( 25 ).…”

The efficacy and safety of dexmedetomidine in preventing emergence delirium in paediatric patients following ophthalmic surgery: a systematic review and meta-analysis of randomised controlled trials

“…In addition, it can lead to electrolyte imbalance and extend the patient's stay in the recovery room [25]. Several studies have recently focused on the effect of dexmedetomidine on PONV, finding that it has an antiemetic effect and may reduce PONV incidence [25,26]. However, the optimal dose to achieve antiemetic effects remains unknown [18].…”