Brazilian Journal of Anesthesiology
Brazilian Journal of Anesthesiology
Original Investigation

Association between intraoperative hypotension and postoperative nausea and vomiting: a retrospective analysis of 247 thyroidectomy cases

Associação entre hipotensão intraoperatória e náuseas e vômitos pós-operatórios: análise retrospectiva de 247 casos de tireoidectomia

Hitomi Nakatani, Yusuke Naito, Mitsuru Ida, Mariko Sato, Naoko Okamoto, Tadashi Nishiwada, Masahiko Kawaguchi

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Postoperative nausea and vomiting (PONV) are major complications after general anesthesia. Although various pathways are involved in triggering PONV, hypotension plays an important role. We hypothesized that intraoperative hypotension during general anesthesia might be responsible for the incidence of PONV.

We retrospectively investigated patients who underwent thyroidectomy. The initial blood pressure measured before induction of anesthesia was used as the baseline value. The systolic blood pressure measured during the operation from the start to the end of anesthesia was extracted from anesthetic records. The time integral value when the measured systolic blood pressure fell below the baseline value was calculated as area under the curve (AUC) of s100%.

There were 247 eligible cases. Eighty-eight patients (35.6%) had PONV. There was no difference in patient background between the patients with or without PONV. Univariate analysis showed that the total intravenous anesthesia (TIVA) (p = 0.02), smoking history (p = 0.02), and AUC-s100% (p = 0.006) were significantly associated with PONV. Multiple logistic regression analysis revealed that TIVA (OR: 0.54, 95% CI: 0.29–0.99), smoking history (OR: 0.60, 95% CI: 0.37–0.96), and AUC-s100% (OR: 1.006, 95% CI: 1.0–1.01) were significantly associated with PONV.

Intraoperative hypotension evaluated by AUC-s100% was related to PONV in thyroidectomy.


Postoperative nausea and vomiting;  PONV;  Hypotension;  Thyroidectomy



Náuseas e vômitos pós-operatórios (NVPO) são complicações importantes após anestesia geral. Embora várias vias estejam envolvidas no desencadeamento de NVPO, a hipotensão desempenha um papel importante. Nossa hipótese é que a hipotensão intraoperatória durante a anestesia geral pode ser responsável pela incidência de NVPO.


Nós investigamos retrospectivamente pacientes submetidos à tireoidectomia. A pressão arterial inicial medida antes da indução da anestesia foi utilizada como valor basal. A pressão arterial sistólica medida durante a operação, do início ao fim da anestesia, foi extraída dos registros anestésicos. O valor integral do tempo quando a pressão arterial sistólica medida caiu abaixo do valor basal foi calculado como área sob a curva (AUC) de s100%.


Houve 247 casos elegíveis. Oitenta e oito pacientes (35,6%) apresentaram NVPO. Não houve diferença no histórico do paciente entre os pacientes com ou sem NVPO. A análise univariada mostrou que a anestesia intravenosa total (AIVT) (p = 0,02), o histórico de tabagismo (p = 0,02) e a AUC-s100% (p = 0,006) estiveram significativamente associados a NVPO. A análise de regressão logística múltipla revelou que AIVT (OR: 0,54, IC 95%: 0,29–0,99), histórico de tabagismo (OR: 0,60, IC 95%: 0,37–0,96) e AUC-s100% (OR: 1,006, IC 95% : 1,0–1,01) foram significativamente associados a NVPO.


A hipotensão intraoperatória avaliada pela AUC-s100% foi relacionada à NVPO na tireoidectomia.


Náuseas e vômitos pós-operatórios; NVPO; Hipotensão; Tireoidectomia


1. L.H. Eberhart, J. Hogel, W. Seeling, et al. Evaluation of three risk scores to predict postoperative nausea and vomiting Acta Anaesthesiol Scand., 44 (2000), pp. 480-488

2. P.S. Glass, P.F. White Practice guidelines for the management of postoperative nausea and vomiting: past, present, and future Anesth Analg., 105 (2007), pp. 1528-1529

3. T.J. Gan Postoperative nausea and vomiting--can it be eliminated? Jama., 287 (2002), pp. 1233-1236

4. C. Phillips, C.D. Brookes, J. Rich, et al. Postoperative nausea and vomiting following orthognathic surgery Int J Oral Maxillofac Surg., 44 (2015), pp. 745-751

5. C.C. Apfel, E. Laara, M. Koivuranta, et al. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers Anesthesiology., 91 (1999), pp. 693-700

6. E. Obrink, P. Jildenstal, E. Oddby, et al. Post-operative nausea and vomiting: update on predicting the probability and ways to minimize its occurrence, with focus on ambulatory surgery Int J Surg., 15 (2015), pp. 100-106

7. L.A.P. Yamada, G.M.N. Guimarães, M.A.S. Silva, et al. Development of a multivariable predictive model for postoperative nausea and vomiting after cancer surgery in adults Rev Bras Anestesiol., 69 (2019), pp. 342-349

8. D.C. Sizemore, B.W. Grose StatPearls (Ed.), Postoperative Nausea, StatPearls Publishing, Treasure Island (FL) (2020)

9. P. Singh, S.S. Yoon, B. Kuo Nausea: a review of pathophysiology and therapeutics Therap Adv Gastroenterol., 9 (2016), pp. 98-112

10. K. Racké, H. Schwörer Regulation of serotonin release from the intestinal mucosa Pharmacol Res., 23 (1991), pp. 13-25

11. J.E. Lee, R.B. George, A.S. Habib Spinal-induced hypotension: Incidence, mechanisms, prophylaxis, and management: Summarizing 20 years of research Best Pract Res Clin Anaesthesiol., 31 (2017), pp. 57-68

12. R.B. George, D.M. McKeen, J.E. Dominguez, et al. A randomized trial of phenylephrine infusion versus bolus dosing for nausea and vomiting during Cesarean delivery in obese women Can J Anaesth., 65 (2018), pp. 254-262

13. J.R. Ortiz-Gomez, F.J. Palacio-Abizanda, F. Morillas-Ramirez, et al. Reducing by 50% the incidence of maternal hypotension during elective caesarean delivery under spinal anesthesia: Effect of prophylactic ondansetron and/or continuous infusion of phenylephrine - a double-blind, randomized, placebo controlled trial Saudi J Anaesth., 11 (2017), pp. 408-414

14. F. Pusch, A. Berger, E. Wildling, et al. The effects of systolic arterial blood pressure variations on postoperative nausea and vomiting Anesth Analg., 94 (2002), pp. 1652-1655

15. P. Kranke, N. Roewer, D. Rusch, et al. Arterial hypotension during induction of anesthesia may not be a risk factor for postoperative nausea and vomiting Anesth Analg., 96 (2003), pp. 302-303

16. A. Ahmadzadeh Amiri, K. Karvandian, M. Ashouri, et al. Comparison of post-operative nausea and vomiting with intravenous versus inhalational anesthesia in laparotomic abdominal surgery: a randomized clinical trial Rev Bras Anestesiol., 70 (2020), pp. 471-476

17. K. Visser, E.A. Hassink, G.J. Bonsel, et al. Randomized controlled trial of total intravenous anesthesia with propofol versus inhalation anesthesia with isoflurane-nitrous oxide: postoperative nausea with vomiting and economic analysis Anesthesiology., 95 (2001), pp. 616-626

18. L. Hallqvist, F. Granath, E. Huldt, et al. Intraoperative hypotension is associated with acute kidney injury in noncardiac surgery: An observational study Eur J Anaesthesiol., 35 (2018), pp. 273-279

19. D.I. Sessler, J.A. Bloomstone, S. Aronson, et al. Perioperative Quality Initiative consensus statement on intraoperative blood pressure, risk and outcomes for elective surgery Br J Anaesth., 122 (2019), pp. 563-574

20. J.B. Bijker, W.A. van Klei, T.H. Kappen, et al. Incidence of intraoperative hypotension as a function of the chosen definition: literature definitions applied to a retrospective cohort using automated data collection Anesthesiology., 107 (2007), pp. 213-220

21. M. Walsh, P.J. Devereaux, A.X. Garg, et al. Relationship between intraoperative mean arterial pressure and clinical outcomes after noncardiac surgery: toward an empirical definition of hypotension Anesthesiology., 119 (2013), pp. 507-515

22. S. Kheterpal, K.K. Tremper, M.J. Englesbe, et al. Predictors of postoperative acute renal failure after noncardiac surgery in patients with previously normal renal function Anesthesiology., 107 (2007), pp. 892-902

23. S.K. Park, E.J. Cho A randomized, double-blind trial of palonosetron compared with ondansetron in preventing postoperative nausea and vomiting after gynaecological laparoscopic surgery J Int Med Res., 39 (2011), pp. 399-407

24. P.F. White, J. Tang, M.A. Hamza, et al. The use of oral granisetron versus intravenous ondansetron for antiemetic prophylaxis in patients undergoing laparoscopic surgery: the effect on emetic symptoms and quality of recovery Anesth Analg., 102 (2006), pp. 1387-1393

25. B.G. Lim, S.S. Choi, Y.J. Jeong, et al. The relationship between perioperative nausea and vomiting and serum serotonin concentrations in patients undergoing cesarean section under epidural anesthesia Korean J Anesthesiol., 67 (2014), pp. 384-390

26. L.F. Mohammad-Zadeh, L. Moses, S.M. Gwaltney-Brant Serotonin: a review J Vet Pharmacol Ther., 31 (2008), pp. 187-199

27. B. Brenner, J.T. Harney, B.A. Ahmed, et al. Plasma serotonin levels and the platelet serotonin transporter J Neurochem., 102 (2007), pp. 206-215

28. G.M.N. Guimarães, H. Silva, H.A. Ashmawi Risk factors for post-caesarean nausea and vomiting: a prospective prognostic study Rev Bras Anestesiol., 70 (2020), pp. 457-463

29. C.C. Apfel, A. Meyer, M. Orhan-Sungur, et al. Supplemental intravenous crystalloids for the prevention of postoperative nausea and vomiting: quantitative review Br J Anaesth., 108 (2012), pp. 893-902

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