Evaluation of penehyclidine for prevention of post operative nausea and vomitting in patients undergoing total thyroidectomy under total intravenous anaesthesia with propofol-remifentanil

Abstract

Backgroud Postoperative nausea and vomiting (PONV) is one of the most common complications after total thyroidectomy under general anesthesia. Total intravenous anesthesia (TIVA) has been documented to prevent PONV in patients undergoing total thyroidectomy. Penehyclidine, an anticholinergic agent with an elimination half-life of over 10 h, is widely used as premedication to reduce glandular secretion. This study aimed to explore the preventative effects of penehyclidine with propofol-remifentanil-TIVA to single-TIVA on PONV in patients undergoing total thyroidectomy. Methods A total of 100 patients scheduled for total thyroidectomy were randomly assigned to either the penehyclidine group (n = 50) or TIVA group (n = 50). Propofol and remifentanil were was used for TIVA in all patients. No patients who received premedication. Patients were administrated with either 5 ml of normal saline or 0.5 mg of penehyclidine soon after anesthesia induction. The incidence of nausea and vomiting, the severity of nausea, the requirement of rescue antiemetics, and adverse effects were investigated during the first 24 h in two time periods (0–2 h and 2–24 h). Results The overall PONV incidence during the 24 h after surgery was significantly lower in the penehyclidine group compared with the TIVA group (12% vs 36%, P < 0.005). Besides, the incidence of nausea and the incidence of vomiting were significantly lower in the penehyclidine group compared with the TIVA group at 2–24 h after surgery. However, there was no significant difference between the two groups at 0–2 h after surgery. Conclusions Administration of penehyclidine under TIVA with propofol-remifentanil is more effective for prevention of PONV than TIVA alone, especially 2–24 h after total thyroidectomy. Trial registration https://www.chictr.org.cn/edit.aspx?pid=132463&htm=4 (Ref: ChiCTR2100050278, the full date of first registration: 25/08/2021).

Penehyclidine for Prevention of Postoperative Nausea and Vomiting in Patients Undergoing Gynecological Laparoscopic Surgery Under Combined Intravenous and Inhalation Anesthesia: A Randomized, Double-Blind, Placebo-Controlled Trial

“…In a recent prospective study of 100 patients with total thyroidectomy, Lu et al found that a single dose of intravenous penehyclidine after induction of anesthesia significantly reduced the incidence of PONV, especially 2–24 h after thyroidectomy. 17 In another prospective study of 228 pediatric patients undergoing strabismus surgery, Sun et al found a significant reduction in the incidence and severity of PONV 48 h after induction of anesthesia in patients given pentaethyl ether (0.01 mg/kg, maximal dose 0.5 mg, intravenously). 15 However, Ding et al found that penehyclidine (bolus 5mg, IV) did not reduce the incidence and severity of postoperative PONV in bariatric surgery patients.…”

“…13,14 Previous studies have shown that the mechanism of penehyclidine reducing the incidence of PONV is complex, which may be related to its blocking of the muscarinic acetylcholine receptor, which is involved in the development of PONV through various mechanisms. Recent clinical studies have shown that penehyclidine for prevention of PONV has made good progress in some surgical procedures, such as ophthalmology, 15 laparoscopic bariatric surgery, 16 thyroid surgery 17 and stomatology surgery. 18 Patients undergoing gynecological laparoscopic surgery are at high risk for PONV.…”

Prevention of postoperative nausea and vomiting after orthognathic surgery: a scoping review

“…In the pathogenesis of PONV, the activation of muscarinic acetylcholine receptor plays an important part [ 45 ]. Penehyclidine, a new muscarinic antagonist with high selectivity of the M3 receptor, is widely used as premedication to reduce glandular secretion [ 46 ]. Not only in orthognathic surgery but another two studies in thyroidectomy and strabismus surgery found that penehyclidine was helpful in preventing PONV [ 46 , 47 ].…”

“…Penehyclidine, a new muscarinic antagonist with high selectivity of the M3 receptor, is widely used as premedication to reduce glandular secretion [ 46 ]. Not only in orthognathic surgery but another two studies in thyroidectomy and strabismus surgery found that penehyclidine was helpful in preventing PONV [ 46 , 47 ]. The major concern of penehyclidine is potential cognitive side effect.…”