Risk factors for postoperative nausea and vomiting

Abstract

Although the aetiology of postoperative nausea and vomiting is not completely clear, a number of key contributing factors increase the risk for an individual patient. The inhalational agents are variably associated with postoperative nausea and vomiting, and nitrous oxide is particularly emetogenic. Older inhalational anaesthetics, such as cyclopropane, are associated with a high incidence, while the currently used agents, isoflurane, enflurane and halothane, cause less, but still significant postoperative nausea and vomiting. Intravenous anaesthetics are also associated with differing degrees of emesis, though the newer agent, propofol, may be less emetogenic than the older anaesthetics. Opioids, used extensively throughout surgery, are further strong emetogens. Patient factors are also important--postoperative nausea and vomiting is three times more prevalent in adult females than in males, and children are around twice as susceptible as adults. Furthermore, a previous history of postoperative nausea and vomiting or motion sickness is a known risk factor. Superimposed on this is the type of surgery--abdominal and gynaecological surgery are particularly emetogenic, and the incidence of postoperative nausea and vomiting following strabismus surgery is high. Increased quality of healthcare, and a growing awareness of the importance of patient satisfaction, are providing new incentives to ensure that postoperative nausea and vomiting is dealt with adequately.

Omitting Antagonism of Neuromuscular Block: Effect on Postoperative Nausea and Vomiting and Risk of Residual Paralysis. A Systematic Review

“…Because these effects are partly prevented by anticholinergic drugs, such as atropine, it was suggested that omitting antagonism of neuromuscular block decreases the risk of PONV because anticholinergic drugs are given concomitantly with antagonism. 21 Finally, in healthy volunteers, intrathecal neostigmine caused severe nausea and vomiting in a dose-dependent manner. 22 These authors suggested that the most likely site of this adverse effect was in the brainstem.…”

Additive anti-emetic efficacy of prophylactic ondansetron with droperidol in out-patient gynecological laparoscopy

“…The use of opioid analgesics (e.g. morphine and codeine in this study) is needed to control postoperative pain but they also increase the incidence of PONV 1,34,35 especially in outpatients who become mobile more quickly. 3 6 The use of opioid analgesics did not vary among the study groups (Table II).…”

Nitrous Oxide Does Not Aggravate Postoperative Emesis After Orthognathic Surgery in Female and Nonsmoking Patients

“…7,8 The Consensus Guideline for Managing PONV classified large amount of information into five levels of evidence based on study design (I-V) and three strengths of recommendation based on expert opinion (A-C). 8 In the guideline, patient-specific risk factors include female sex (IA), nonsmoking status (IV A) and a history of PONV or motion sickness (IV A).…”

“…Some anesthetics such as nitrous oxide and volatile anesthetics including sevoflurane, supplemental agents such as opioids, neostigmine, female patient, nonsmoking status and a history of postoperative nausea and vomiting (PONV) are risk factors for PONV. 7,8 In contrast, since propofol has a strong antiemetic effect after general anesthesia, 7,8 propofol anesthesia may be a good choice for orthognathic surgery.…”