Comparison Of Propofol, Dexamethasone, And Metoclopramide For Prophylaxis Of Postoperative Nausea And Vomiting After Thyroidectomy

Objective: To compare the efficacy of a subhypnotic dose of propofol with dexamethasone and metoclopramide for the prophylaxis of postoperative nausea and vomiting after thyroidectomy. Methods: In this study,100 patients with nodular goiter, scheduled for thyroidectomy, were randomized to 1 of 4 groups to receive IV administration of propofol 0.5㎎/㎏, dexamethasone 10㎎, metoclopramide 10㎎ or placebo (isotonic saline) immediately after skin suture as intervention. Each study group comprised 25 patients. Anesthesia was induced with 0.1㎎/㎏ midazolam, 4μg/kg fentanyl and 0.1㎎/㎏ vecuronium and was maintained using 1.0%～3.0% sevoflurane for all patients. All episodes of PONV including its severity during the first 24 hours after anesthesia were recorded. Also, extrapyramidal symptoms and intraoperative awareness was recorded. Results: The prevalences of PONV 0 to 24 hours after anesthesia were statistically significant lower in propofol group and dexamethasone group, compared with metoclopramide group and and placebo group(P<0.05). A statistically significant difference was found when compared the severity of PONV of four groups: propofol group, dexamethasone group, metoclopramide group and placebo group(P<0.05). Whereas no statistically significant difference was observed in comparison of the severity of PONV between any two groups from the four groups(P>0.01). Extrapyramidal symptoms and intraoperative awareness were not reported in any of group. Conclusion: In this study with patients scheduled for thyroidectomy, the prevalences of PONV 0 to 24 hours after anesthesia were lower in propofol group and dexamethasone group than in metoclopramide group or placebo group. There is the same efficacy between propofol and dexamethasone in the prophylaxis of PONV after thyroidectomy.