Effects Of Mannitol And Tropisetron Hydrochloride On Headache, Dizziness, Nausea And Vomiting After Thyroidectomy

Objective: To evaluate the effects of different dose of mannitol and tropisetron hydrochloride alleviating symptoms of headache,dizziness,nausea and vomiting after thyroidectomy.At present, many diseases of the thyroid gland need to be treated with surgical operations,while these surgical treatments may be produce many complications.The most common symptoms are headache,dizziness, nausea,and vomiting after thyroidectomy among these complications.The incidence of nausea and vomiting after thyroidectomy is higher obviously than that after other types of surgery.Many researches point out that the higher incidence of nausea and vomiting after thyroidectomy is closely related to gender,age,anesthesia method,anesthetic,operation time,anesthesia time,operative position,changes of vertebral artery blood flow,etc.Moreover,the role of operative position is considered as the major reason which leads to headache,dizziness,nausea and vomiting after thyroidectomy.During thyroid surgery,the operation,instrument of oppression and postoperative trauma edema make venous reflux obstructed which can lead to edema of the nervous system secondary and the intracranial pressure increased.The edema of nervous system and the increasement of intracranial pressure play an important role in the patient’s headache,dizziness,nausea and vomiting after thyroid surgery.Mannitol is sorbitol isomers,and it can increase the plasma osmotic pressure after entering the body,so it can dehydrate and decrease the intracranial pressure.Since mannitol is able to reduce intracranial pressure and prevent cerebral hernia,it often is used to treat the cerebral edema due to a variety of causes.Tropisetron hydrochloride is a powerful and high selection competitive antagonist of 5-HT3 receptor in the peripheral and central nervous system and often is used to prevent the occurrence of postoperative nausea and vomiting.This research is focus on the effectiveness of different dose of mannitol and tropisetron hydrochloride alleviating symptoms of headache,dizziness,nausea and vomiting after thyroidectomy.The results of this research provide evidence to guide the clinical application and to relieve discomfort of patients.Method: During the period of October 2013 to May 2014, 90 patients undergone thyroid surgery,including thyroid cancer radical prostatectomy, thyroid neoplasm resection and partial resection of the thyroid gland,were selected.Including cases as follows:①ASA I or patients;Ⅱ ②age in the range from 18 to 60 years old;③patients with cardiac function I or Ⅱ.Excluding cases as follows:①patients who have an allergy to mannitol or 5-HT3 receptor antagonist;②patients with serious disfunction of liver and kidney;③patients with headache history,mental disorder history and the vertigo history; ④patients who took chemotherapy and anti-nausea drugs in the past week;⑤patients with gastrointestinal obstruction,digestive tract ulcer history and reflux esophagitis history;⑥patients who need further treatment in ICU with the endotracheal tube after thyroidectomy;⑦the operation time over 2 hours.Approved by hospital ethics committee,ninety patients were randomized into 3 groups(n=30,each group) as follows:The patients of first group marked as A was given 2mg tropisetron hydrochloride plus 125 ml 0.9% physiological saline;The patients of second group marked as B was given 2mg tropisetron hydrochloride plus 125 ml 20% mannitol;The patients of third group marked as C was given 2mg tropisetron hydrochloride plus 250 ml 20% mannitol.All patients were given 2mg tropisetron hydrochloride while anesthesia induction.Then,according to different group,these patients were given 125 ml 0.9% physiological saline,125 ml 20% mannitol or 250 ml 20% mannitol respectively 15 minutes before the end of surgery.After the surgery,observed and recorded the symptoms of headache,dizziness in 6 hours,12 hours and 24 hours with VAS(Visual Analogue Scale),and observed and recorded the symptoms of nausea,vomiting in 6 hours,12 hours and 24 hours with the valuation standard of the United States.The general information was recorded in the case data,including name,gender,age,height,weight,Body Mass Index(BMI),the number of intubation,operation time,the way of operation,the dosage of anesthetic,etc.Statistical software SPSS 15.0 was used to deal with the data.Measurement data represent mean±standard deviation(SD),and analysis of variance was used for the difference among groups.Enumeration data was marked as percentage,and Chi-square test was used for data analysis. Rank test was used for hierarchical data.For all test,p value<0.05 was considered statistically significant.Result: There was no significant difference in the gender,age, height,weight,and BMI among the three groups(P>0.05).There was no significant difference in the number of intubation,operation time,and the anesthetic dosage among all groups(P>0.05).The incidence of headache and dizziness was 10.0% in group C at the time point of 6th hour after operation,the incidence of headache and dizziness was 30.0% in group B at the time point of 6th hour after operation,and the incidence of headache and dizziness was 50.0% in group A at the time point of 6th hour after operation;The incidence of headache and dizziness was 3.3% in group C at the time point of 12 th hour after operation,the incidence of headache and dizziness was 16.7% in group B at the time point of 12 th hour after operation,and the incidence of headache and dizziness was 36.7% in group A at the time point of 12 th hour after operation.The incidence of headache and dizziness was significantly lower in group C than in group A at the time points of 6th hour and 12 th hour after operation(P<0.05);however,there was no significant difference at the 24 th hour among the three groups(P>0.05).Meanwhile,the incidence of nausea and vomiting was 6.7% in group C at the time point of 6th hour after operation,the incidence of nausea and vomiting was 20.0% in group B at the time point of 6th hour after operation,and the incidence of nausea and vomiting was 40.0% in group A at the time point of 6th hour after operation.The incidence of nausea and vomiting was significantly lower in group C than in group A at the 6th hour after operation(P<0.05);but there was no significant difference at the 12 th hour and 24 th hour among the three groups(P>0.05).Conclusions: The combined application of 250 ml 20% mannitol and 2mg tropisetron hydrochloride can effectively reduce symptoms of headache, dizziness, nausea and vomiting after thyroidectomy.