Abstract
BackgroundBleeding after thyroidectomy occurs due to violent coughing during emergence. Dexmedetomidine is helpful for the smooth emergence and suppression of cough. The purpose of the present study was to compare the effects of dexmedetomidine on postoperative bleeding after thyroidectomy.MethodsRandomized, double-blind, controlled trials were conducted in female patients (ASA I–II, aged 20 to 60 years). The patients were randomly allocated into two groups. Approximately 15 min before the end of the surgery, dexmedetomidine was administered (0.6 µg/kg/h) without a loading dose in group D (n = 69), and normal saline was administered in group S (n = 70) at the same infusion rate. Hemodynamic data, coughing reflex, extubation time, Ramsay sedation scale (RSS), and recovery time were assessed during the administration of the study drugs and recovery from anesthesia. The amount of postoperative hemorrhage was measured for 3 days.ResultsData from a total of 139 patients were analyzed. The incidence of severe cough was significantly lower in group D than in group S (4.3 % vs. 11.5 %, P = 0.022). The emergence agitation in the postanesthetic care unit was significantly lower in group D than in group S (P = 0.01). Postoperative bleeding was significantly lower in group D than in group S until the second postoperative day (P = 0.015).ConclusionsDexmedetomidine can be helpful in decreasing bleeding after thyroidectomy by reducing coughing and emergence agitation.Trial registrationThis study was registered at http://clinicaltrials.gov (registration number NCT02412150, 09/04/2015).
Highlights
Bleeding after thyroidectomy occurs due to violent coughing during emergence
When the patients agreed to participate in the study, the envelopes were opened in sequential order and the patients were allocated according to the number into two groups: Group D (n = 69): Dexmedetomidine (Precedex®; Pfizer, New York, NY, USA) was administered (0.6 μg/kg/h) after stopping the administration of remifentanil 15 min before the end of surgery; Group S (n = 70): Normal saline was administered as a control in the same way
A total of 140 patients were enrolled, but one patient in group D was excluded because of re-operation according to the biopsy results
Summary
Bleeding after thyroidectomy occurs due to violent coughing during emergence. The purpose of the present study was to compare the effects of dexmedetomidine on postoperative bleeding after thyroidectomy. Many cases of post-thyroidectomy bleeding occur due to violent cough that develops while waking up from anesthesia and during extubation [2]. Various trials have examined the effects of administering remifentanil or dexmedetomidine on suppressing cough during the extubation period and emergence [3, 4]. A small dose of dexmedetomidine is effective in suppressing cough during emergence from anesthesia without respiratory depression [4]. A small dose of dexmedetomidine may reduce postoperative bleeding after thyroidectomy by reducing cough and emergence agitation. No studies have shown if the effect of dexmedetomidine on reducing emergence agitation and cough can reduce postoperative bleeding after thyroidectomy
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