Postoperative nausea and vomiting after endoscopic thyroidectomy: total intravenous vs. balanced anesthesia

Abstract

BackgroundEndoscopic thyroidectomy was recently introduced and has been rapidly accepted by surgeons and patients. The present study was conducted to estimate and compare the incidences of postoperative nausea and vomiting (PONV) after endoscopic thyroidectomy using two different anesthetic methods: sevoflurane based balanced anesthesia; total intravenous anesthesia (TIVA).MethodsNinety nine female patients that were scheduled to undergo elective endoscopic thyroidectomy under general anesthesia were enrolled. These patients were randomly allocated to receive sevoflurane based balanced anesthesia (BA group) or propofol-remifentanil anesthesia (TIVA group). PONV was evaluated using a 4-point Likert scale, and pain using a visual analogue scale (VAS; range 0 to 100) for 0-2, 2-6, and 6-24 hours postoperatively. At 24 hours postoperatively, overall patient satisfaction regarding PONV and pain were recorded.ResultsThe incidence of PONV was 14.6% in the TIVA group and 51.3% in the BA group. The incidence of nausea at 0-2 and 2-6 hours postoperatively was lower in the TIVA group than in the BA group (4.2% vs. 35.9%, 6.3% vs. 23.1%, respectively), but no between-group difference was observed at 6-24 hours postoperatively (8.3% vs. 5.1%). Antiemetic usage at 0-2 and 2-6 hours was lower in the TIVA than the BA group (4.2% vs. 38.5%, 6.3% vs. 23.1%), but no between-group difference was observed for 6-24 hours (6.3% vs. 7.7%). There were no differences in pain or in patient satisfaction.ConclusionsAfter endoscopic thyroidectomy, total intravenous anesthesia with propofol-remifentanil is associated with less PONV during the early postoperative period (0-6 hours) than sevoflurane based balanced anesthesia.

Post-Operative Effects: Comparison of Total Intravenous and Inhalational Anesthesia

“…This finding confirms studies that indicate there is no difference in the total recovery time of patients anesthetized with TIVA using propofol and patients anesthetized with inhalational anesthesia using sevoflurane [6,12].…”

“…These results contradict studies that found the incidence of PONV to be significantly reduced in patients that received TIVA with propofol compared to patients that received inhalational anesthesia using sevoflurane [6,9,10] or inhalational anesthesia using other volatile anesthetics [11,12]. Although our study was limited by the number of patients enrolled (n=23), our findings are consistent with other larger studies that compared the incidence of PONV in patients anesthetized with TIVA using propofol and patients anesthetized with inhalational anesthesia using sevoflurane.…”

“…This finding is consistent with Anker-Møller et al [4]'s study which determined that propofol, in subhypnotic doses, reduces the amplitude of the pain-evoked potential while increasing the pain threshold. While our findings regarding a VAS pain rating greater than 4 between the two groups supports research that has found early post-operative pain to be less in patients anesthetized with TIVA using propofol [1,2], a lack of significant p-value between the means reported by both groups cannot conclusively refute studies that found there to be no difference in pain between patients anesthetized with TIVA using propofol and inhalational anesthesia using sevoflurane [5,6].…”

Effects of intra‐operative maintenance of general anaesthesia with propofol on postoperative pain outcomes – a systematic review and meta‐analysis

“…Eight studies investigated postoperative nausea and vomiting, with 371 patients receiving propofol and 354 patients receiving inhalational anaesthesia [10,19,20,22,24,25,28,30]. Propofol was associated with a significant reduction in postoperative nausea and vomiting (relative risk (95% CI) 0.446 (0.304-0.656) (p < 0.0001) (Fig.…”

A Randomized Controlled Trial Comparing the Efficacy of P6 Acupuncture Plus Ondansetron versus Ondansetron or P6 Acupuncture in the Prevention of Nausea and Vomiting after Bupivacaine-Morphine Spinal Anesthesia

“…Then, the prevention and treatment of nausea and vomiting have become important subjects in anesthesiology [3]. Currently, even with new anesthetic techniques, which involve the use of prophylactic agents and the selection of anesthetics with lower emetic potentials, the incidence of PONV has not decreased and is still approximately 20% to 30% [4] [5] [6].…”