The Cure for Postoperative Vomiting

Parkhouse, James

doi:10.1093/bja/35.3.189

Cited by 13 publications

(5 citation statements)

References 22 publications

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“…Parkhouse suggested that visceral or pelvic pain was a common cause of nausea. 44 Andersen and Krohg in a study during the first 12 to 24 postoperative hours noted that only ten per cent of patients had episodes of pain without nausea, whereas 58.6 per cent of patients experienced pain with nausea. 45 Perhaps more surprising was their finding that opiates given intravenously relieved both nausea and pain in 80 per cent of these episodes, they concluded "relief of pain and persistent nausea was uncommon and if pain relief was inadequate nausea was unabated."…”

Section: Postoperative Factorsmentioning

confidence: 97%

“…~3 Opiates are thought to sensitise the vestibular apparatus and so postoperative movments have an important influence on the frequency of opiate induced emesis. 44 The authors' personal experaence after visiting a large group of postoperative dental patients within 24 hours was that the majority of patients who had emetic symptoms said that they had occurred while getting out of bed. This observation could also have been the result of hypotension although this was not recorded at the time.…”

Section: Postoperative Factorsmentioning

confidence: 99%

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Anaesthesia and emesis. I: Etiology

1984

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One of the most distressing side effects following anaesthesia is the occurrence of nausea, often followed by retching and vomiting.In a review of the subject in 1963 Riding felt that postoperative "sickness" was less frequent and severe than in the preceding twenty years. ~ However, examination of more recent literature suggests that the incidence of postoperative "sickness" has probably not changed although its severity may have. It is, however, difficult to compare these studies as there was little attempt by many authors to define nausea, retching, or vomiting, indeed postoperative "sickness" is often used interchangeably with these terms. The studies variably included one or all of these symptoms; population samples, anaesthetic conditions, and periods of follow up also differed (Table I).This article will review our current understanding of the physiology of emesis (nausea, retching and vomiting) and evaluates the part played by anaesthesia in its aetiology. In a second review we will examine the methods and agents available to anaesthetists for prevention or treatment of emetic symptoms. Clearly there are several factors not directly related to anaesthesia that influence the incidence of emetic episodes (nausea, retching, or vomiting). These factors include metabolic, vestibular and psychogenic disturbances, gastro-intestinal and intraeranial disorders and administration of agents with emetic potential such as ergometrine.In these cases there is often little the anesthetist can do to influence the primary pathology and so brief mention will be made of these.

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Section: Postoperative Factorsmentioning

confidence: 97%

Section: Postoperative Factorsmentioning

confidence: 99%

Anaesthesia and emesis. I: Etiology

1984

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“… Pain: Visceral or pelvic pain is a common cause of postoperative emesis[ 25 26 ] Ambulation: Sudden motion, changes in position, transport from the postanesthetic recovery unit to the postsurgical ward can precipitate nausea and vomiting in patients who have received opioid compounds[ 25 26 27 28 ] Opioids: Postoperative opioids increase risk for PONV in a dose-dependent manner;[ 29 ] this effect appears to last for as long as opioids are used for pain control in the postoperative period. [ 30 ] Irrespective of route of administration, the incidence of nausea and vomiting appears to be similar.…”

Section: Postoperative Factorsmentioning

confidence: 99%

“…Ambulation: Sudden motion, changes in position, transport from the postanesthetic recovery unit to the postsurgical ward can precipitate nausea and vomiting in patients who have received opioid compounds[ 25 26 27 28 ]…”

Section: Postoperative Factorsmentioning

confidence: 99%

Postoperative nausea and vomiting: A simple yet complex problem

et al. 2016

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Postoperative nausea and vomiting (PONV) is one of the complex and significant problems in anesthesia practice, with growing trend toward ambulatory and day care surgeries. This review focuses on pathophysiology, pharmacological prophylaxis, and rescue therapy for PONV. We searched the Medline and PubMed database for articles published in English from 1991 to 2014 while writing this review using “postoperative nausea and vomiting, PONV, nausea-vomiting, PONV prophylaxis, and rescue” as keywords. PONV is influenced by multiple factors which are related to the patient, surgery, and pre-, intra-, and post-operative anesthesia factors. The risk of PONV can be assessed using a scoring system such as Apfel simplified scoring system which is based on four independent risk predictors. PONV prophylaxis is administered to patients with medium and high risks based on this scoring system. Newer drugs such as neurokinin-1 receptor antagonist (aprepitant) are used along with serotonin (5-hydroxytryptamine subtype 3) receptor antagonist, corticosteroids, anticholinergics, antihistaminics, and butyrophenones for PONV prophylaxis. Combination of drugs from different classes with different mechanism of action are administered for optimized efficacy in adults with moderate risk for PONV. Multimodal approach with combination of pharmacological and nonpharmacological prophylaxis along with interventions that reduce baseline risk is employed in patients with high PONV risk.

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“…The mechanism of PONY after uterine and gynaecological surgery is unclear. Packing the uterus and pelvic pain have been implicated as possible mechanisms [64].…”

Section: Gynaecological Surgerymentioning

confidence: 99%

Surgical and Patient Factors Involved in Postoperative Nausea and Vomiting

Lerman¹

1992

British Journal of Anaesthesia

382

220

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Seventy-five years ago, Flagg suggested that postoperative vomiting may result from causes other than anaesthetics: "there are at least three kinds of vomiting", the first of which he attributed to anaesthetics such as ether, the second to reflex responses, that is pain or ovarian surgery, and the last to opioids, for example morphine [30]. Before this report, anaesthetics alone were thought to be responsible for most postoperative nausea and vomiting (PONV). Subsequent investigations unfolded a spectrum of non-anaesthetic factors in the pathogenesis of PONY including age, gender, motion sickness, body habitus, surgical site and postoperative feeding procedures. This review summarizes our current understanding of the roles of two categories of non-anaesthetic factors, patient and surgical factors, in the pathogenesis of PONY. Despite the recent advances in modern anaesthesia, only modest progress has been made in our understanding and treatment of PONY. Early studies reported incidences of PONY as high as 75-80 cYo after opioid premedication and prolonged ether anaesthesia [4,11,13,47,83,84]. In many of these reports, the patient population, premedication, anaesthetic and the surgical procedure were not controlled. In the second half of this century, however, these incidences have decreased by almost 50 % for various reasons [7,

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The Cure for Postoperative Vomiting

Cited by 13 publications

References 22 publications

Anaesthesia and emesis. I: Etiology

Anaesthesia and emesis. I: Etiology

Postoperative nausea and vomiting: A simple yet complex problem

Surgical and Patient Factors Involved in Postoperative Nausea and Vomiting

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