Prevention of postoperative nausea and vomiting with rapid sequence induction and intubation in patients undergoing thyroidectomy: a randomized controlled trial.

PURPOSE: Postoperative nausea and vomiting (PONV) remains a major clinical challenge undergoing thyroidectomy. The study aimed to investigate the effect of rapid sequence induction and intubation (RSI) on the incidence of PONV in patients undergoing thyroidectomy. METHODS: Adult patients were randomized 1:1 to the RSI group (no assisted ventilation before endotracheal intubation) or the control group (face-mask pressure-controlled ventilation during induction). A standardized general anesthesia protocol and PONV prophylaxis strategy with dexamethasone and ondansetron was implemented for all patients. The primary outcome was the overall incidence of PONV in ward within 24h after surgery. Secondary outcomes were the incidence of PONV in post-anesthesia care unit (PACU), the use of rescue antiemetic, gastric antral cross-sectional area (CSA), and the incidence of adverse events. Sensitivity analysis includes intention-to-treat assessment to test robustness. RESULTS: A total of 214 patients were included in the per-protocol analysis (RSI n=106, control n=108). The overall PONV incidence (13.2% vs. 28.7%, P=0.007) was significantly lower in the RSI group compared with the control group. Similarly, the post-induction antral CSA was significantly reduced in the RSI group (349.1 ± 131.7 mm2 vs. 412.9 ± 144.8 mm2, P<0.001). Within the control group, a positive association was suggested between post-induction CSA grade and PONV incidence (Spearman's ρ = 0.93, P = 0.023). There were no significant differences between groups in the incidence of PONV in PACU, transient desaturation or the need for rescue mask ventilation during induction. CONCLUSIONS: RSI was associated with reduced 24-hour PONV and decreased gastric antral distension, without increasing airway adverse events, when compared with standard mask-ventilated induction in elective thyroidectomy patients. TRIAL REGISTRATION: This study was registered in the Chinese Clinical Trials Registry (ChiCTR2100042241, date of registration: 17/1/2021, prospectively registered).