Evaluation of combination antiemetic prophylaxis in high risk emetogenic patients undergoing thyroid surgery: A randomized double-blind study

BackgroundThis study was designed to find out the effective antiemetic drug for prevention of postoperative nausea and vomiting in high risk emetogenic patients undergoing thyroid surgery.Patients and methodsOne hundred twenty patients, ASA I, II, subjected to elective thyroid surgery were enrolled in this study. Patients were randomly assigned, according to antiemetic prophylaxis, into three groups, each consisted of 40 patients. Patients received 4 mg ondansetron plus 8 mg dexamethasone (Group II) i.v. or 2 mg midazolam plus 8 mg dexamethasone (Group III) i.v. or saline (Group I) just after induction of anesthesia. Frequency of nausea, vomiting, the use of antiemetics, the complete response (defined as no PONV and no administration of rescue antiemetic drug) were recorded at three time points (6 h, 12 h, 24 h) postoperatively.ResultsWe found that ondansetron/dexamethasone or midazolam/dexamethasone significantly increased the complete response, compared with placebo, with an incidence of 90%, 85%, and 22.5%, respectively at 6 h, 90%, 87.5%, 25%, respectively, at 12 h and 95%, 92.5%, 47.5%, respectively at 24 h postoperatively.ConclusionWe conclude that the prophylactic use of ondansetron/dexamethasone or midazolam/dexamethasone, compared with placebo, was effective for reducing nausea and vomiting in patients undergoing thyroid surgery. Midazolam/dexamethasone is preferred due to its cost relative to ondansetron/dexamethasone.