Abstract
To determine the effectiveness of pharmacologic interventions for preventing postoperative nausea and vomiting (PONV) in patients undergoing thyroidectomy. Systematic review and network meta-analysis (NMA). MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Google Scholar. 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. 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). 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. CRD42018100002.
Highlights
Postoperative nausea and vomiting (PONV) are the most common and unpleasant complications after anesthesia induction and surgery, and could result in aspiration pneumonia, fluid and electrolyte imbalances, and esophageal rupture [1,2,3]
According to the surface under the cumulative ranking curve (SUCRA) values, the incidence of postoperative nausea and vomiting (PONV) among the overall postoperative phases was lowest with propofol alone (16.1%), followed by palonosetron (27.5%), and with tropisetron (28.7%)
Propofol and tropisetron alone and in combination, and the ramosetron and dexamethasone combination effectively prevented PONV, postoperative nausea (PON), postoperative vomiting (POV) in patients undergoing thyroidectomy, with some heterogeneity observed in this network meta-analysis (NMA) of full-text reports
Summary
Postoperative nausea and vomiting (PONV) are the most common and unpleasant complications after anesthesia induction and surgery, and could result in aspiration pneumonia, fluid and electrolyte imbalances, and esophageal rupture [1,2,3]. Vomiting after thyroidectomy may increase the incidence and severity of postsurgical complications, such as surgical wound dehiscence, postoperative hemorrhage, or neck hematoma, and in the worst case, airway obstruction might occur due to hematoma [7, 8]. The incidence of PONV after thyroidectomy increased to 60–84% when no prophylactic antiemetic is given [2, 11, 12], as surgical handling of neck during thyroidectomy induces intense vagal stimulation, and patients receiving thyroidectomy are mostly young or middle-aged women, in whom the risk of PONV is high [2]. The findings of these studies are conflicting and variable
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