Oesophageal Rupture in a Patient with Postoperative Nausea and Vomiting

A, Baric

doi:10.1177/0310057x0002800315

Cited by 19 publications

(10 citation statements)

References 20 publications

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“…Complications are usually rare and minor but sometimes can be severe (4). PONV can also delay or compromise patient discharge in ambulatory practice, thereby increasing medical costs (4–10).…”

Section: Introductionmentioning

confidence: 99%

Incidence of postoperative nausea and vomitingin paediatric ambulatory surgery

Villeret

Laffon

Duchalais

et al. 2002

Pediatric Anesthesia

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Section: Introductionmentioning

confidence: 99%

Incidence of postoperative nausea and vomitingin paediatric ambulatory surgery

Villeret

Laffon

Duchalais

et al. 2002

Pediatric Anesthesia

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“…Traumatic rupture of the lower oesophagus is a well‐recognised complication of forceful retching and vomiting, and is much more common in patients with a history of pre‐existing oesophageal disease such as reflux oesophagitis. Cases have been described in association with postoperative nausea and vomiting [4] and pregnancy [5], as well as with the application of cricoid pressure [6], but we can find no reported cases associated with a viral gastroenteritis‐type illness.…”

Section: Discussionmentioning

confidence: 86%

Viral gastroenteritis – a danger to the patient, a danger to the staff

Appelboam

Hammond

2004

Anaesthesia

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SummaryViral gastroenteritis is usually a mild, self-limiting illness. We report a case of a previously well 74-year-old woman who suffered a grave complication of this common condition, and caused a significant outbreak of illness amongst staff involved in her care. This case highlights the risks of Hospital Acquired Infection and raises important infection control issues. It illustrates the hazards associated with exposure to potentially infectious secretions and presents a clear message to medical and nursing staff involved in the care of the acute surgical emergency.Keywords Gastroenteritis. Infection control. A 74-year-old woman was admitted to the Emergency Department of our hospital in the early hours of the morning with a suspected ruptured abdominal aortic aneurysm. She had clear risk factors for an aneurysm: she was hypertensive, had ischaemic heart disease and had a strong family history (both siblings had died suddenly following ruptured aneurysms). She had a short history of severe epigastric pain radiating through to her back associated with dizziness, near syncope and vomiting. Although there was a suggestion of some gastrointestinal upset during the preceding 24 h, the surgical diagnosis was one of abdominal aortic aneurysm. On arrival, she was unwell and clearly shocked. Her blood pressure was 100 ⁄ 60 mmHg, her pulse rate 126 beats.min )1 and her SpO 2 91% on maximal facemask oxygen. Her presenting hypotension responded initially to a 1000-ml fluid bolus, but the pain persisted and she remained tachycardic and in respiratory distress. Her abdomen was rigid and distended, and it was thought that her respiratory distress was partly due to this. She was transferred to the operating theatre for an emergency laparotomy whilst being resuscitated. Assessment by the consultant vascular surgeon in the operating theatre following initial fluid resuscitation raised some doubts about the initial diagnosis of ruptured aortic aneurysm; however, it was clear that there was some serious intra-abdominal pathology that required definitive diagnosis and treatment. Results of initial blood tests were not available at this time. After placement of a wide bore central line and an arterial line, anaesthesia was induced with 250 lg fentanyl, 2 mg midazolam and 75 mg thiopental, followed by 100 mg succinylcholine. Her trachea was intubated with some difficulty with a 7-mm cuffed tracheal tube, and thereafter anaesthesia was maintained with isoflurane in oxygen ⁄ air. At laparotomy, the team was surprised to find no intra-abdominal pathology at all. Her clinical condition remained unstable and she required extensive intravenous fluids and vasopressor support, initially in the form of boluses of 1 mg metaraminol but later an epinephrine infusion. Her ventilation was satisfactory, with normal airway pressures and acceptable gas exchange.In view of the negative operative findings but her poor and deteriorating clinical condition, the available history and investigation results were re-examined. The patient had been taken t...

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“…[6] In previous studies, the incidence of PONV was reported between 20–80% depends on the type of surgery and existence of risk factors. Although mortality is rare, PONV can result in serious complications and has been shown to be a cause of unhealing of surgical wounds, pain, esophageal injury, dehydration, hypokalemia, alkalosis, intraocular hemorrhage, increase ICP, myocardial ischemia and in rare conditions pneumonia aspiration and death[27–9]…”

Section: Introductionmentioning

confidence: 99%

“…[14] Among these drugs, midazolam that is a short-acting drug with rapid onset of action in the benzodiazepine class has shown more safety and lack of serious side effects in PONV prophylaxis when used before or after induction of anesthesia. [289111418] There are also some reports of antiemetic effect of midazolam in patients who were resistant to traditional antiemetics. Dexamethasone is also a well-established antiemetic in patient receiving cancer chemotherapy and is most effective for preventing PONV when it is administered immediately before induction of anesthesia rather than near the end of anesthesia.…”

Section: Introductionmentioning

confidence: 99%

Comparing the preventive effect of midazolam and midazolam-dexamethasone on postoperative nausea and vomiting in elective middle ear surgery

Heidari

Yaraghi

2012

Adv Biomed Res

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Background:Nausea and vomiting are common postoperative complications with incidence of 20–80% depends on the surgery type, anesthetic drugs, age, sex, etc. This complication may lead to patient discomfort, intraocular, and intracerebral pressures increase, sutures rupture, esophageal injury, and rarely death. Many studies reported that midazolam and dexamethasone alone can decrease postoperative nausea and vomiting (PONV), but their combination has never been studied yet. The aim of this study was to compare the effect of midazolam and midazolam-dexamethasone on PONV after middle ear surgery.Materials and Methods:66 ASA I and II patients aged 15–65 year scheduled for elective middle ear surgery under general anesthesia randomly divided into two groups. Immediately after induction of the anesthesia group one (M) received midazolam 0.075 mg/kg and group two (M+D) received combination of midazolam (0.075 mg/kg) plus dexamethasone (0.05 mg/kg). Then the severity of nausea was measured by visual analog scales 0–10 (VAS) in recovery room at 6, 12, and 24 h after surgery. Metoclopramid (0.1 mg/kg) was administrated I.V. slowly if nausea score was above 3 or patient had vomiting. The postoperative need for antiemetics and the duration of stay in recovery room were recorded. Values of P<0.05 were considered statistically significant.Results:There were no significant differences in age, gender, and weight between the two groups. There was no significant difference in the mean nausea scores between two groups except after 12 h postoperatively (1.39 ± 3.19 in M group vs. 0.42 ± 1.71 in M+D group). The mean vomiting frequency was significantly less in midazolam-dexamethasone group in the recovery room (0.9 ± 0.29 vs. 0 ± 0) and at 6–12 h (1.09 ± 2.41 vs. 0.3 ± 0.8), and 12–24 h (0.42 ± 1.32 vs. 0.03 ± 0.17) postoperatively. During the first 24 h postoperatively, the metoclopramid consumption was significantly less in combination therapy (6.48 ± 9.54) than in the midazolam group (12.9 ± 23.44) (Value<0.5).Conclusion:The combination of midazolam-dexametazone is more effective than midazolam alone in prevention of postoperative vomiting after middle ear surgery. Therefore, we recommend combination therapy for patients who are prone to PONV.

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Oesophageal Rupture in a Patient with Postoperative Nausea and Vomiting

Cited by 19 publications

References 20 publications

Incidence of postoperative nausea and vomitingin paediatric ambulatory surgery

Incidence of postoperative nausea and vomitingin paediatric ambulatory surgery

Viral gastroenteritis – a danger to the patient, a danger to the staff

Comparing the preventive effect of midazolam and midazolam-dexamethasone on postoperative nausea and vomiting in elective middle ear surgery

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