Nausea and vomiting

Postoperative nausea and vomiting remain a troublesome and frequent complication of general anesthesia, with an in-hospital incidence varying from 10 to 30 per cent. Predisposing factors include a full stomach (emergency surgery, pregnancy), obesity, gastroschesis, diabetes mellitus, hiatus hernia and/or gastroesophageal reflux, type of surgery, phase of the menstrual cycle in women, and choice of anesthetic (particularly those incorporating higher doses of opioid analgesics and inhalational anesthetics). Vomiting itself may be associated with particular medical risks, as outlined in T.a.b!e.4.. Treatment consists of antiemetic drugs (e.g. droperidol 0.25-0.5 mg intravenously, dimenhydrinate 12.5-25 mg intravenously, ondansetron 4-8 mg intravenously, or a subhypnotic dose of propofol 0.15 mg/kg intravenously) and/or substitution of alternate opioid or non-opioid analgesics for the treatment of postoperative pain. Undesirable side-effects of many antiemetic drugs include sedation (with the exception of ondansetron) and extrapyramidal side-effects or dysphoria with droperidol.

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Table 4 Medical risks of postoperative nausea and vomiting

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