Postoperative Nausea and Vomiting in Adults: Implications for Critical Care

Abstract

Postoperative nausea and vomiting is a dreaded, uncomfortable, and unpleasant patient experience that is also a factor contributing to adverse outcomes in postoperative recovery. The key to management of this concern is to identify high-risk patients and to develop a systematic method of assessment, intervention, and evaluation within the perianesthesia care continuum. This discussion outlines the wide range of pharmacological and alternative therapies that are available in clinical practice with a case study to illustrate incorporation of these interventions in critically ill patients.

Clinical utility of antiemetics and complementary therapies in the prevention of postoperative nausea and vomiting

“…This phase is also sometimes associated with a diminished sensation of nausea. 3,5,19 Patient-specific identified risk factors Nausea …”

“…22 In addition, nonsmokers are at higher risk for postoperative nausea and vomiting; this factor has been validated by many risk factor studies. [2][3][4][5]8,12 One hypothesis for why this occurs is that nicotine blocks liver enzymes that would increase the duration of anesthesia. Apfel et al attribute this characteristic of smokers as that "the protective effect of smoking may be due to functional changes in neuroreceptors from chronic exposure to nicotine, and thus nicotine withdrawal rather than nicotine exposure reduces smokers' susceptibility to PONV."…”

“…It is experienced and interpreted by the patient and is present when the person reports the sensation. 3,7 Nausea is closely linked to the olfactory sense (cranial nerve I). [16][17][18] Other triggers listed in the literature are anxiety, vestibular stimulation, ocular surgery, and hormonal changes with birth control medications or pregnancy.…”

“…Nausea and vomiting occurring with surgery produce two very different outcomes: the first is a situation that is self-limiting and uncomfortable, and that increases length of acute care stay; and the second is a potentially life-threatening set of consequences that can become very costly. [1][2][3] Clinically problematic sequelae of postoperative nausea and vomiting (PONV) are: airway compromise; wound dehiscence; electrolyte imbalance; suture tension; esophageal tears; venous hypertension; surgical site bleeding; and increased intracranial pressure. [2][3][4] PONV clinical manifestations are experienced by millions of patients annually worldwide, and exponentially increase the healthcare costs associated with surgery.…”

“…[1][2][3] Clinically problematic sequelae of postoperative nausea and vomiting (PONV) are: airway compromise; wound dehiscence; electrolyte imbalance; suture tension; esophageal tears; venous hypertension; surgical site bleeding; and increased intracranial pressure. [2][3][4] PONV clinical manifestations are experienced by millions of patients annually worldwide, and exponentially increase the healthcare costs associated with surgery. 1,5,6 Studies consistently report that if not treated prophylactically, 30% of surgical patients experience both postoperative nausea and vomiting.…”