Home > Postoperative nausea and vomiting
Postoperative nausea and vomiting is an unpleasant complication affecting about a third of the 10% of the population undergoing general anaesthesia each year. This equates to about two million people in the United Kingdom annually. 1 Impact
Although it is very rarely fatal, nausea and vomiting can be extremely distressing for patients. In some patients, for example those with wired jaws after maxillofacial surgery, vomiting can be dangerous. About 1% of patients with planned day surgery require overnight admission because of uncontrolled postoperative nausea and vomiting.
2 Management
Because no currently available antiemetic is a gold standard good enough for use on its own, and successful control is often elusive, experts recommend a multimodal approach. Anaesthetic strategies to prevent vomiting include using regional anaesthesia wherever possible and avoiding emetogenic drugs. Pharmacological treatment and prevention of postoperative nausea and vomiting is limited by both cost and the adverse effects of drugs. Patients with risk factors probably warrant prophylaxis, whereas a "wait and see" strategy is appropriate for those without risk factors.
3 Pharmacology
The introduction of the 5HT3 receptor antagonist, ondansetron, in the early 1990s was a significant breakthrough. Despite the many studies, however, the evidence base to support rational antiemetic treatment remains patchy. Recent research has led to better understanding of some older drugs and has demonstrated that combinations of drugs are often useful. While the efficacy of droperidol is now clear, metoclopramide, a popular antiemetic for decades, has been found to have no worthwhile efficacy. Some older drugs, such as haloperidol and hyoscine remain inadequately studied.
Emetogenic drugs commonly used in anaesthesia include nitrous oxide, physostigmine and opioids. The intravenous anaesthetic propofol is currently the least emetogenic general anaesthetic.
4 Risk factors
Postoperative nausea and vomiting results from anaesthesic, surgicalSurgery is the medical specialty that treats diseases or injuries by operative manual and instrumental treatment. Its practitioners are referred to as surgeons''. History of surgery Although surgeons are now considered to be specialised physicians, the pr, and patients factors. Gynaecological, urological, or middle ear surgery increases the risk of postoperative nausea and vomiting. Patients that are female or have a past history of postoperative nausea and vomiting are at greater risk. SmokingFor information about smoking tobacco, see tobacco smoking. For information about other substances that can be smoked, see cannabis, hashish, cocaine, DMT, heroin, PCP, and methamphetamine. For information about curing meat, see smoking (food) For informa decreases the risk, but this would never be recommended by any physician.
5 Reference
- Tramèr MR. Treatment of postoperative nausea and vomiting. BMJThe British Medical Journal (BMJ) is a medical journal published weekly in the United Kingdom by the British Medical Association (BMA). Its editor-in-chief is Richard Smith. External links Medical journals. 2003;327:762-3. Fulltext. [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids= } Medline abstract] (PMID }).
6 See also
- NauseaNausea is the sensation of unease and discomfort from the stomach, with the sufferers feeling that they may vomit. Nausea is a symptom of many conditions, including motion sickness, morning sickness during pregnancy, viral infections, and other diseases.
- VomitingVomiting (or emesis is the forceful expulsion through the mouth of the contents of one's stomach. It is a mechanism for expelling ingested illness-causing food poisons. The act may be triggered by stimuli which might indicate the possibility of poisoning,
- Antiemetic
AnesthesiaAnesthesia ( AE), also anaesthesia ( BE), is the process of blocking the perception of pain and other sensations. This allows patients to undergo surgery and other procedures without the distress and pain they would otherwise experience. There are several
