Postoperative Vomiting

Surgery and Operations

Author: Deutsches Aerzteblatt International
Published: 2010/11/04
Contents: Summary - Introduction - Main - Related

Synopsis: Nearly 30% of all patients suffer from nausea and vomiting after surgery.

Introduction

Nearly 30% of all patients suffer from nausea and vomiting after surgery.

Main Digest

The financial repercussions of this are longer patient stays in the recovery room, with increased need for personnel. Appropriate prophylaxis and treatment can prevent postoperative nausea and vomiting. In a systematic review of the literature, Dirk Rusch and co-authors investigate how treatment recommendations for nausea after general anesthesia can be improved (Dtsch Arztebl Int 2010; 107[42]: 733 741).

The pathogenesis of postoperative nausea remains unclear, but it has been possible to identify some risk factors. Patient-dependent risk factors include female sex, susceptibility to motion sickness, and nonsmoker status. On the basis of such factors, established prognosis systems can be used to assess risks and identify high-risk patients.

There are compatible, thoroughly evaluated antiemetics available for prophylaxis in children and adults. When these substances are combined from groups with different active ingredients, their effects are cumulative.

To treat postoperative nausea, the authors recommend swift administration of drugs and close monitoring.

Information on Vomiting after Surgery - (Editor Added)

On average the incidence of nausea or vomiting after general anesthesia ranges between 25 and 30%.

Vomiting has been associated with major complications such as pulmonary aspiration of gastric content and might endanger surgical outcomes after certain procedures, for example after maxillofacial surgery with wired jaws. Nausea and vomiting can delay discharge and about 1% of patients scheduled for day surgery require unanticipated overnight admission because of uncontrolled postoperative nausea and vomiting.

Because no currently available antiemetic is especially effective by itself, and successful control is often elusive, experts recommend a multimodal approach. Anesthetic 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.

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, was found to have limited efficacy at the lower traditional dosage. 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 anesthetic propofol is currently the least emetogenic general anesthetic.

Postoperative nausea and vomiting results from anesthetic, surgical, and patients factors. Gynaecological, urological, strabismus correction and middle ear surgery all have a higher risk of postoperative nausea and vomiting. Patients that are female or who have a history of postoperative nausea and vomiting are at greater risk. Smokers have a decreased risk, but this would never be recommended by any physician. Older patients suffer less Postoperative nausea and vomiting.

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