Continuum-based protocol offers new strategy for preventing PONV after thyroidectomy

Editor's Note

Postoperative nausea and vomiting (PONV) remain a significant concern in thyroidectomy patients, with incidence rates reaching up to 80% in high-risk groups, Medical Dialogues April 25 reports. Despite effective intraoperative and postanesthesia care unit (PACU) protocols, gaps often arise during patient transitions to wards or intensive care units, leading to prolonged recovery, increased healthcare costs, and diminished patient satisfaction. To address these challenges, a novel continuum-based PONV prophylaxis protocol (CBPPP) has been developed, accompanied by a practical checklist for clinical application. ​

The CBPPP was formulated through a comprehensive review of existing guidelines, systematic reviews, meta-analyses, and primary research on PONV prevention, emphasizing studies from the last decade to ensure contemporary relevance. Contributions from the Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting significantly informed the understanding of effective antiemetic pharmacotherapy and perioperative interventions. ​

Key components of the CBPPP include:​

• Risk stratification: Identifying patients at high risk for PONV to tailor prophylactic strategies accordingly
• Multimodal antiemetic therapy: Utilizing a combination of antiemetic agents targeting different receptors to enhance efficacy
• Perioperative interventions: Implementing measures such as adequate hydration, minimizing opioid use, and employing regional anesthesia techniques when feasible.

The protocol emphasizes the importance of a seamless transition of care, ensuring that PONV prevention strategies initiated in the OR and PACU are continued and adapted as patients move to different care settings. This approach aims to maintain consistent prophylaxis, reduce the incidence of PONV, and improve overall patient outcomes.