Skip to main content
SpringerLink
Log in

Antiemetic prophylaxis in thyroid surgery: a randomized, double-blind comparison of three 5-HT3 agents

  • Original Article
  • Published:
Journal of Anesthesia Aims and scope Submit manuscript

Abstract

Purpose

The aim of this double-blind randomized study was to compare the antiemetic efficacy of three 5-hydroxytryptamine type 3 antagonists in terms of the incidence and intensity of postoperative nausea and vomiting (PONV) in a homogenous group of female patients undergoing thyroidectomy.

Methods

The study cohort consisted of 203 American Society of Anesthesiologists PS I–II female patients randomized into four groups to receive at induction of anesthesia an intravenous (IV) bolus of 5 ml solution of one of the following: normal saline (placebo), granisetron 3 mg, ondansetron 4 mg, or tropisetron 5 mg. Nausea and vomiting were evaluated at five time points: during the first hour in the postanesthesia care unit (PACU) and 6, 12, 18, and 24 h postoperatively. Nausea intensity was measured using a visual analogue scale score (0–10).

Results

Patients in the placebo group displayed a high incidence of nausea in the PACU and at 6, 12, and 18 h postoperatively (44, 60, 50, and 34%, respectively) and of vomiting (26, 42, 30 and 10%). The administration of granisetron reduced significantly the incidence of nausea at 6, 12, and 18 h (26, 18, and 2%, respectively) and vomiting at 6 and 12 h (10 and 6%, respectively). Ondansetron reduced significantly the incidence of nausea and vomiting only at 6 h postoperatively (28 and 12%, respectively). The administration of tropisetron did not affect the incidence of PONV compared to placebo.

Conclusion

Among the female patients of this study undergoing thyroid surgery, granisetron 3 mg provided the best prophylaxis from PONV. Ondansetron 4 mg was equally effective, but its action lasted only 6 h, whereas tropisetron 5 mg was found ineffective.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Gan TJ. Postoperative nausea and vomiting: can it be eliminated? JAMA. 2002;287:1233–6.

    Article  PubMed  Google Scholar 

  2. Watcha MF, White PF. Postoperative nausea and vomiting: its etiology, treatment and prevention. Anesthesiology. 1992;77:162–84.

    Article  PubMed  CAS  Google Scholar 

  3. Andrews PLR. Physiology of nausea and vomiting. Br J Anaesth. 1992;69:2S–19S.

    Article  PubMed  CAS  Google Scholar 

  4. Camu F, Lauwers MH, Verbessen D. Incidence and aetiology of postoperative nausea and vomiting. Eur J Anaesthesiol Suppl. 1992;6:25–31.

    PubMed  CAS  Google Scholar 

  5. Gan TJ. Risk factors for postoperative nausea and vomiting. Anesth Analg. 2006;102:1884–98.

    Article  PubMed  Google Scholar 

  6. Gan T, Meyer T, Apfel CC, Chung F, Davis PJ, Habib AS, Hooper VD, Kovac AL, Kranke P, Myles P, Philip BK, Samsa G, Sessler DI, Temo J, Tramer MR, Kolk GV, Watcha M. Consensus guidelines for managing postoperative nausea and vomiting. Anesth Analg. 2007;105:1615–28.

    Article  PubMed  Google Scholar 

  7. Watcha MF. Nausea and vomiting: choice of drugs and treatment. Curr Opin Anaesthesiol. 1996;9:300–5.

    Article  Google Scholar 

  8. Fujii Y. The benefits and risks of different therapies in preventing postoperative nausea and vomiting in patients undergoing thyroid surgery. Curr Drug Saf. 2008;3:27–34.

    Article  PubMed  CAS  Google Scholar 

  9. Jokela R, Koivuranta M, Kangas-Saarela T, Purhonen S, Alahuhta S. Oral ondansetron, tropisetron or metoclopramide to prevent postoperative nausea and vomiting: a comparison in high-risk patients undergoing thyroid or parathyroid surgery. Acta Anaesthesiol Scand. 2002;46:519–24.

    Article  PubMed  CAS  Google Scholar 

  10. Boogaerts JG, Vanacher E, Seidel I, Albert A, Bardian FM. Assessment of postoperative nausea using a visual analogue scale. Acta Anaesthesiol Scand. 2000;44:470–4.

    Article  PubMed  CAS  Google Scholar 

  11. http://www.dssresearch.com/toolkit/sscalc/size_p2.asp 2010 Decision Support Systems, LP. All Rights Reserved.

  12. Ho KY, Gan TJ. Pharmacology, pharmacogenetics, and clinical efficacy of 5-hydroxytryptamine type 3 receptor antagonists for postoperative nausea and vomiting. Curr Opin Anaesthesiol. 2006;19:606–11.

    Article  PubMed  Google Scholar 

  13. Roila F, Del Favero A. Ondansetron clinical pharmacokinetics. Clin Pharmacokinet. 1995;29:95–109.

    Article  PubMed  CAS  Google Scholar 

  14. Tramer MR, Reynolds DJ, Moore RA, McQuay HJ. Efficacy, dose-response, and safety of ondansetron in prevention of postoperative nausea and vomiting: a quantitative systematic review of randomized placebo-controlled trials. Anesthesiology. 1997;87:1277–89.

    Article  PubMed  CAS  Google Scholar 

  15. Bouly A, Nathan N, Feiss P. Prevention of postoperative nausea and vomiting by ondansetron. Ann Fr Anesth Reanim. 1992;11:496–501.

    PubMed  CAS  Google Scholar 

  16. Korttila K, Clergue F, Leeser J, Feiss P, Olthoff D, Payeur-Michel C, Wessel P, Nave S, Hahne W, Brown R. Intravenous dolasetron and ondansetron in prevention of postoperative nausea and vomiting: a multicenter, double-blind, placebo-controlled study. Acta Anaesthesiol Scand. 1997;41:914–22.

    Article  PubMed  CAS  Google Scholar 

  17. Pearman MH. Single dose IV ondansetron in the prevention of postoperative nausea and vomiting. Anaesthesia. 1994;49:11–5.

    Article  PubMed  Google Scholar 

  18. Figueredo ED, Canosa LG. Ondansetron in the prophylaxis of postoperative vomiting: a meta-analysis. J Clin Anesth. 1998;10:11–21.

    Article  Google Scholar 

  19. Chimbira W, Sweeney BP. The effect of smoking on postoperative nausea and vomiting. Anaesthesia. 2000;55:540–4.

    Article  PubMed  CAS  Google Scholar 

  20. Ionescu D, Badescu C, Acalovschi I. Nicotine patch for the prevention of postoperative nausea and vomiting: a prospective randomized trial. Clin Drug Investig. 2007;27:559–64.

    Article  PubMed  CAS  Google Scholar 

  21. Fujii Y, Saiton Y, Tanaka H, Toyooka H. Prophylactic antiemetic therapy with granisetron in women undergoing thyroidectomy. Br J Anaesth. 1998;8:526–8.

    Google Scholar 

  22. D’Angelo R, Philip B, Gan TJ, Kovac A, Hantler C, Doblar D, Melson T, Minkowitz H, Dalby P, Coop A. A randomized, double-blind, close ranging, pilot study of intravenous granisetron in the prevention of postoperative nausea and vomiting in patients undergoing abdominal hysterectomy. Eur J Anaesthesiol. 2005;22:774–9.

    Article  PubMed  Google Scholar 

  23. Carmichel J, Cantwell BMJ, Edwards CM, Zussman BD, Thompson S, Rapeport WG, Harris AL. A pharmacokinetic study of granisetron (BRL43694A), a selective 5-HT3 receptor antagonist: correlation with antiemetic response. Cancer Chemother Pharmacol. 1989;24:45–59.

    Google Scholar 

  24. Chan MT, Chui PT, Ho WS, King WW. Single-dose tropisetron for preventing postoperative nausea and vomiting after breast surgery. Anesth Analg. 1998;87:931–5.

    PubMed  CAS  Google Scholar 

  25. Akin A, Esmaoglu AE, Gunes I, Boyacu A. The affects of the prophylactic tropisetron propofol combination on postoperative nausea and vomiting in patients undergoing thyroidectomy under desflurane anesthesia. Mt Sinai Med. 2006;73:560–3.

    Google Scholar 

  26. Sun R, Klein KW, White PF. The effect of timing of ondansetron administration in outpatients undergoing otolaryngologic surgery. Anesth Analg. 1997;84:331–6.

    PubMed  CAS  Google Scholar 

  27. Tang J, Wang B, White PF, Watcha MF, Qi J, Wender RH. The effect of timing of ondansetron administration on its efficacy, cost-effectiveness, and cost-benefit as a prophylactic antiemetic in the ambulatory setting. Anesth Analg. 1998;86:274–82.

    PubMed  CAS  Google Scholar 

  28. Fischer V, Baldeck JP, Tse FL. Pharmacokinetics and metabolism of the 5-hydroxytryptamine antagonist tropisetron after single oral doses in humans. Drug Metab Dispos. 1992;20:603–7.

    PubMed  CAS  Google Scholar 

  29. Zofran (ondansetron hydrochloride) injection premixed (prescribing information). Research Triangle Park, NC; GlaxoSmithKline; 2006. Available at: http://www.drugs.com/monograph/ondansetron-hydrochloride.html.

  30. Kytril (granisetron hydrochloride) injection (prescribing information). Nutley, NJ: Roche Pharmaceuticals; 2006. Available at: https://www.medicinescomplete.com/mc/ahfs/current/login.htm.

  31. Kaiser R, Sezer O, Papies A, Bauer S, Schelenz C, Tremblay PB, Possinger K, Roots I, Brockmoller L. Patient-tailored antiemetic treatment with 5-hydroxytryptamine type 3 receptor antagonists according to cytochrome P-450 2D6 genotypes. J Clin Oncol. 2002;20:2805–11.

    Article  PubMed  CAS  Google Scholar 

  32. Janicki PK, Schuler HG, Jarzembowski TM, Rossi M 2nd. Prevention of postoperative nausea and vomiting with granisetron and dolasetron in relation to CYP2D6 genotype. Anesth Analg. 2006;102:1127–33.

    Article  PubMed  CAS  Google Scholar 

  33. Aspinall LR, Goodman NW. Denial of effective treatment and poor quality of clinical information in placebo controlled trials of ondansetron for postoperative nausea and vomiting: a review of published trials. Br Med J. 1995;311:844–6.

    CAS  Google Scholar 

  34. Tramer MR. A rational approach to the control of postoperative nausea and vomiting: evidence from systematic reviews. Part I. Efficacy and harm of antiemetic interventions and methodological issues. Acta Anaesthesiol Scand. 2001;45:4–13.

    Article  PubMed  CAS  Google Scholar 

Download references

Conflict of interest

There are no conflicts of interest related to the study.

Author information

Authors and Affiliations

  1. Department of Anesthesiology, University Hospital of Heraklion, Heraklion, Crete, Greece

    Maria Metaxari & Aikaterini Chatzimichali

  2. Medical School, University of Crete, P.O. Box 2208, 71003, Heraklion, Crete, Greece

    Alexandra Papaioannou & Helen Askitopoulou

  3. Department of Anesthesiology, University Hospital of Ioannina, Ioannina, Greece

    Anastasios Petrou

  4. Department of Anesthesiology, General Hospital of Paphos, Paphos, Cyprus

    Elena Pharmakalidou

Authors
  1. Maria Metaxari
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alexandra Papaioannou
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anastasios Petrou
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Aikaterini Chatzimichali
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Elena Pharmakalidou
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Helen Askitopoulou
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alexandra Papaioannou.

About this article

Cite this article

Metaxari, M., Papaioannou, A., Petrou, A. et al. Antiemetic prophylaxis in thyroid surgery: a randomized, double-blind comparison of three 5-HT3 agents. J Anesth 25, 356–362 (2011). https://doi.org/10.1007/s00540-011-1119-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00540-011-1119-2

Keywords

Search

Navigation