Joris JL, Poth NJ, Djamadar AM, et al. Supplemental oxygen does not reduce postoperative nausea and vomiting after thyroidectomy

Department of Anesthesiology, University of Louisville, Louisville, Kentucky, United States
BJA British Journal of Anaesthesia (Impact Factor: 4.85). 01/2004; 91(6):857-61. DOI: 10.1093/bja/aeg267
Source: PubMed


Supplemental intra-operative oxygen 80% halves the incidence of nausea and vomiting after open and laparoscopic abdominal surgery, perhaps by ameliorating intestinal ischaemia associated with abdominal surgery. It is unlikely that thyroid surgery compromises intestinal perfusion. We therefore tested the hypothesis that supplemental perioperative oxygen does not reduce the risk of postoperative nausea and vomiting (PONV) after thyroidectomy.
One hundred and fifty patients undergoing thyroidectomy were given sevoflurane anaesthesia. After induction, patients were randomly assigned to the following treatments: (i). 30% oxygen, (ii). 80% oxygen, or (iii). 30% oxygen with droperidol 0.625 mg.
The overall incidence of nausea during the first 24 h after surgery was 48% in the patients given oxygen 30%, 46% in those given oxygen 80%, and 22% in those given droperidol (P=0.004). There were no significant differences between the oxygen 30% and 80% groups in incidence or severity of PONV, the need for rescue antiemetics, or patient satisfaction. Droperidol significantly shortened the time to first meal.
Supplemental oxygen was ineffective in preventing nausea and vomiting after thyroidectomy, but droperidol reduced the incidence.

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    • "Thyroid surgery is a surgery with a relatively higher PONV incidence of 60-84% [3]. The main cause of PONV after thyroid surgery is not entirely clear, but it is thought to result from the surgical procedure (surgical handling of neck structures), female sex, use of volatile anesthetics, non-smoking, postoperative opioid use, history of motion sickness or previous PONV history [13]. PONV could adversely affect patients who have received thyroid surgery, as vomiting can cause, or exacerbate, postoperative bleeding inside the surgery site. "
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    ABSTRACT: Postoperative nausea and vomiting (PONV) occurs in up to 63-84% of patients after thyroid surgery. This study aims to assess the effects of using a capsicum plaster to reduce PONV after thyroid surgery at either the Chinese acupuncture point (acupoint) Pericardium 6 (P6) or Korean hand acupuncture point K-D2. One-hundred eighty-four patients who underwent thyroid surgery were randomized in four groups (n = 46 each): control group = inactive tape at P6 acupoints and on both shoulders as a nonacupoint; P6 group = capsicum plaster at P6 points and inactive tape on both shoulders; K-D2 group = capsicum plaster at K-D2 acupoints and inactive tape on both shoulders; Sham group = capsicum plaster on both shoulders and inactive tape at P6 acupoints. The capsicum plaster was applied before the induction of anesthesia and removed at 8 hr after surgery. The incidence and severity of nausea and vomiting and the need for rescue antiemetics were decreased in the patients in the P6 and K-D2 groups compared to the patients in the control and sham groups (P < 0.001). The patients in the P6 and K-D2 groups also reported that they were more satisfied (P < 0.05). We conclude that the capsicum plaster at the P6 and K-D2 acupoint was a promising antiemetic method for the patients undergoing thyroid surgery.
    Korean journal of anesthesiology 12/2013; 65(6):539-43. DOI:10.4097/kjae.2013.65.6.539
    • "Most probably, the etiology of PONV after thyroidectomy is multifactorial and, unlike chemotherapy-induced nausea and vomiting, one cannot expect the same efficacy of antiemetics.[29] Thyroidectomy is an operation that causes strong vagal stimuli due to the surgical manipulation of the neck structures. "
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    ABSTRACT: Postoperative nausea and vomiting (PONV) are frequently encountered after thyroidectomy. For PONV prevention, selective serotonin 5-hydroxytryptamine type 3 (5-HT3) receptor antagonists are considered one of the first-line therapy. We report on the efficiency of granisetron and tropisetron, with that of placebo on the prevention of PONV in patients undergoing total thyroidectomy. One hundred twenty-seven patients were divided into three groups and randomized to receive intravenously, prior to induction of anesthesia, tropisetron 5 mg, or granisetron 3 mg, or normal saline. All patients received additionally 0.625 mg droperidol. All episodes of postoperative PONV during the first 24 h after surgery were evaluated. Nausea visual analogue scale (VAS) score was lower in tropisetron and granisetron groups than the control group at all measurements (P<0.01) except for the 8-h measurement for tropisetron (P=0.075). Moreover, granisetron performed better than tropisetron (P<0.011 at 4 h and P<0.01 at all other points of time) apart from the 2-h measurement. Vomiting occurred in 22.2%, 27.5%, and 37.5% in granisetron, tropisetron, and control groups, respectively (P=0.43). The combination of the 5-HT3 antagonists with droperidol given before induction of anesthesia is well tolerated and superior to droperidol alone in preventing nausea but not vomiting after total thyroidectomy.
    03/2013; 7(1):68-74. DOI:10.4103/1658-354X.109817
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    • "Riesgo de sesgo: incierto o alto 19 50 28.7% 1.18 [0.53, 2.63] 2003 21 Joris 2003 50 17 50 26.0% "
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    ABSTRACT: Objective To evaluate the effectiveness and safety of oxygen supplementation (inspired fraction of oxygen, FiO2) in high concentrations versus low concentrations, given with the aim of reducing complications in patients undergoing surgical procedures under general anesthesia.MethodsA systematic review and a meta-analysis were performed following the methodology proposed by the Cochrane Collaboration. The review included controlled clinical trials conducted in patients undergoing surgical procedures under general anesthesia. After conducting data base searches (PUBMED, CENTRAL y LILACS), and once the relevant studies were identified, additional snowballing ambispective and grey literature searches were done.ResultsOf the 17 clinical trials finally included (4844 patients), 7 were considered to a have a low risk of bias. High FiO2 levels reduce post-operative nausea and vomiting only in surgeries with extensive intestinal manipulation (odds ratio [OR] 0.40; 95% confidence interval [CI], 0.20 to 0.80). In this same clinical setting, the risk of surgical site infection (OR 0.46; 95% CI, 0.29 to 0.74), and mortality (OR 0.17; 95% CI, 0.03 to 0.99) are also reduced. There was no impact on the need for rescue anti-emetic administration, length of stay in the post-anesthetic care unit, unexpected admission to the intensive care unit, or postoperative hospital stay in any of the surgical populations.Conclusions Intra-operative oxygen supplementation in high concentrations (≥ 60%) might reduce the risk of surgical site infection and mortality in surgeries with extensive intestinal manipulation.
    Revista Colombiana de Anestesiologia 02/2012; 40(1):34–51. DOI:10.1016/S0120-3347(12)70009-6
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