Pharmacologic interventions for postoperative nausea and vomiting after thyroidectomy

Cho, Ye Jin; Choi, Geun Joo; Kang, Hyun

doi:10.1097/md.0000000000014542

Cited by 4 publications

(8 citation statements)

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“…PONV has always been a major concern for anesthesiologists, as it is known to occur in up to 60% to 84% of patients after thyroidectomy if prophylactic antiemetics are not administered. [ 25 ] Therefore, most of the studies on postoperative complications after thyroidectomy are based on anesthesia methods or related drugs to reduce PONV or postoperative pain. However, postoperative pain after thyroidectomy is known to be mild to moderate.…”

Section: Discussionmentioning

confidence: 99%

“…[ 26 , 27 ] PONV can cause complications such as aspiration pneumonia, fluid and electrolyte imbalances, or esophageal rupture, increasing the length of the patient’s hospital stay and medical costs and reducing the patient’s satisfaction with the surgery. [ 25 , 28 ] In particular, if it occurs after thyroidectomy, it may cause bleeding in or rupture of the surgical site, leading to airway obstruction due to hematoma in severe cases. [ 25 ]…”

Section: Discussionmentioning

confidence: 99%

“…[ 25 , 28 ] In particular, if it occurs after thyroidectomy, it may cause bleeding in or rupture of the surgical site, leading to airway obstruction due to hematoma in severe cases. [ 25 ]…”

Section: Discussionmentioning

confidence: 99%

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Comparison of the effects of sevoflurane and desflurane on the severity score of postoperative pain and discomfort after thyroidectomy: A prospective, double-blinded, randomized controlled study

Park

2022

Medicine

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Background: Thyroidectomy is performed under general anesthesia using inhaled anesthetics such as sevoflurane or desflurane in many cases. The objective of this study was to investigate whether the incidence of postoperative pain and discomfort after thyroidectomy differed with the type of inhaled anesthetic.Methods: Eighty-one female patients who underwent thyroidectomy were randomly assigned to the Sevo group (n = 42) or the Des group (n = 39). On the day of surgery and on the first, third, and seventh days after surgery, one registered nurse in charge of the entire questionnaire survey conducted the questionnaire assessment through face-to-face interviews or phone calls with the patients. The questionnaire evaluated the severity scores for seven items (sore throat, wound pain, nausea and vomiting, dizziness, occipital headache, posterior neck pain, and shoulder pain) regarding postoperative pain and discomfort experienced by patients and assessed which of these seven items caused the greatest discomfort to the patient on each day.Results: Except for the severity score for dizziness on the day of surgery, the severity scores of postoperative pain and discomfort experienced by patients on the day of surgery and on the first, third, and seventh days after surgery showed no statistically significant differences between the two groups. In addition, on the day of surgery and on the first, third, and seventh days after surgery, patients reported that sore throat caused the greatest discomfort. Conclusion:In patients undergoing thyroidectomy under general anesthesia using sevoflurane or desflurane, except for dizziness on the day of surgery, no other manifestation of postoperative pain and discomfort was influenced by the type of inhaled anesthetic. Moreover, after thyroidectomy, postoperative sore throat caused the greatest discomfort to patients from the day of surgery to the seventh day after surgery.Abbreviations: ASA = American Society of Anesthesiologists, BIS = bispectral index, BMI = body mass index, bpm = beats per minute, CPSP = chronic postsurgical pain, ENT = Ear-Nose-and-Throat, PONV = postoperative nausea and vomiting, TIVA = total intravenous anesthesia.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Comparison of the effects of sevoflurane and desflurane on the severity score of postoperative pain and discomfort after thyroidectomy: A prospective, double-blinded, randomized controlled study

Park

2022

Medicine

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“…We developed the protocol for this systematic review and NMA according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) protocol statement [ 22 ] and registered it with the International Registration of Prospective Systematic Reviews (PROSPERO network); registration number: CRD42018100002; accessible at ( https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=100002 ), and published in a peer-reviewed journal [ 23 ].…”

Section: Methodsmentioning

confidence: 99%

Pharmacologic interventions for postoperative nausea and vomiting after thyroidectomy: A systematic review and network meta-analysis

et al. 2021

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Objective To determine the effectiveness of pharmacologic interventions for preventing postoperative nausea and vomiting (PONV) in patients undergoing thyroidectomy. Design Systematic review and network meta-analysis (NMA). Data sources MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Google Scholar. Eligibility criteria, participants, and interventions Randomized clinical trials that investigated the efficacy of pharmacologic interventions in preventing PONV in patients undergoing thyroidectomy were included. The primary endpoints were the incidences of postoperative nausea and vomiting (PONV), postoperative nausea (PON), postoperative vomiting (POV), use of rescue antiemetics, and incidence of complete response in the overall postoperative phases. The secondary endpoints were the same parameters assessed in the early, middle, and late postoperative phases. The surface under the cumulative ranking curve (SUCRA) values and rankograms were used to present the hierarchy of pharmacologic interventions. Results Twenty-six studies (n = 3,467 patients) that investigated 17 different pharmacologic interventions were included. According to the SUCRA values, the incidence of PONV among the overall postoperative phases was lowest with propofol alone (16.1%), followed by palonosetron (27.5%), and with tropisetron (28.7%). The incidence of PON among the overall postoperative phases was lowest with propofol alone (11.8%), followed by tropisetron and propofol combination (14%), and ramosetron and dexamethasone combination (18.0%). The incidence of POV among the overall postoperative phases was lowest with tropisetron and propofol combination (2.2%), followed by ramosetron and dexamethasone combination (23.2%), and tropisetron alone (37.3%). The least usage of rescue antiemetics among the overall postoperative phases and the highest complete response was observed with tropisetron and propofol combination (3.9% and 96.6%, respectively). Conclusion Propofol and tropisetron alone and in combination, and the ramosetron and dexamethasone combination effectively prevented PONV, PON, POV in patients undergoing thyroidectomy, with some heterogeneity observed in this NMA of full-text reports. Their use minimized the need for rescue antiemetics and enhanced the complete response. Trial registration number CRD42018100002.

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“…Studies have reported that, if not treated, ~35% of patients will develop nausea, vomiting, or both symptoms after surgery, which is a very painful experience, even more serious than postoperative pain ( 6 ). However, ~60–80% of patients develop nausea and vomiting after thyroidectomy without antiemetic prophylaxis, which may result in severe complications, such as aspiration pneumonia caused by accidental inhalation of vomitus or postoperative neck hematoma and even airway obstruction caused by hematoma ( 7 ). PONV often prolongs the patient's stay in the recovery room or even the discharge time, which is the main reason for accidental readmission after elective surgery ( 8 ).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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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.

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Pharmacologic interventions for postoperative nausea and vomiting after thyroidectomy

Abstract: Supplemental Digital Content is available in the text

Cited by 4 publications

References 32 publications

Comparison of the effects of sevoflurane and desflurane on the severity score of postoperative pain and discomfort after thyroidectomy: A prospective, double-blinded, randomized controlled study

Comparison of the effects of sevoflurane and desflurane on the severity score of postoperative pain and discomfort after thyroidectomy: A prospective, double-blinded, randomized controlled study

Pharmacologic interventions for postoperative nausea and vomiting after thyroidectomy: A systematic review and network meta-analysis

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

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