NAUSEA AND VOMITING

 

 

 

Case: A 30-year-old woman following surgery.

INTRODUCTION

Nausea and Vomiting have been commonly observed in several post-operative cases, including minor and ambulatory surgery. This often leads to a delay in discharging the patient, and is usually associated with the use of general anaesthesia. While improvements in operative techniques, anaesthesia practice and the identification of the patients predisposed to emetic tendencies has considerably reduced the number of such cases to about 20-30 per cent, there still remain several instances of post-operative nausea and vomiting (Islam and Jain, 2004), (Becker, 2010).

PHYSIOLOGY AND MECHANISMS INVOLVED IN NAUSEA AND VOMITING

Distinct terms that tend to be used in conjunction with each other, Nausea is the feeling or need felt any an individual to vomit. Vomiting, on the other hand, refers to the actual expulsion of contents in the gastro intestinal region orally (Becker, 2010). Vomiting results from the  direct or indirect simulation of the vomiting centre or as a simulation of either one or a combination of  four sites, namely chemoreceptor trigger zone, Gastro intestinal tract, visual system or the vestibular system (Rahman and Beattie 2008).  The act of vomiting commences from the contraction of the digestive tract or lower areas which results in impulses in the vomiting centre or other identified sites. The intrinsic contractions culminate in the expulsion of vomitus into the mouth (Becker, 2010).

IDENTIFICATION OF RED FLAGS

Prominent red flags for a 30-year-old post-operative female patient include prior history of PONV, anxiety, history on non-smoking, migraine and motion sickness and are not related to estrogen in any manner. However, none of these factors may be considered an ideal and reliable independent predictor of Post-operative Nausea Vomiting (Becker, 2010). Dehydration, electrolyte disturbance, nutrition, wound dehiscence as well as rare instances of aspiration pneumonitis are the commonly occurring morbidity known to be associated with PONV (Rahman and Beattie 2008).

PRINCIPLES OF MANAGEMENT AND CURRENT GUIDANCE

Treatment of nausea and prevention of vomiting is easier than controlling vomiting once it has started. The recommend treatment includes the use of prophylactic agents (which is determined based on risk as well as the efficiency of the agents) including Antihistamines, dopamine antagonists, anticholinergic drugs benzamides, phenothiazines, 5HT3 antagonists butyrophenones and other agents; or through alternative treatments including Chinese acupuncture which should commence in the preoperative phase and continue during the post-operative phase. Peppermint given as an infusion or ginger once patients starts drinking and eating normally are also recommended and simple alternatives for treatment of Post-operative Nausea Vomiting (Rahman and Beattie 2008).

IDENTIFICATION OF POSSIBLE TREATMENT

While many studies have attempted to identify suitable treatment for Post-operative Nausea Vomiting, the matter still remains in a grey area. While antiemetic drugs are seen to act as a deterrent at receptor sites, there remains an inconsistency in the studies and possible treatment for the same. This is primarily due to the difficulty in factoring the various causes and contributors to both vomiting and nausea (Becker, 2010).

 

 

 

REFERENCES

Becker, D. (2010). Nausea, Vomiting, and Hiccups: A Review of Mechanisms and Treatment. Anesthesia Progress, 57(4), pp.150-157.

Islam, S., Jain, P.N. (2004). Post-operative nausea and vomiting (PONV): A review Article. Indian Journal of Anaesthetics; 48(4), pp 253-258.

Rahman, M.H., Beattie, J. (2008). Post-operative nausea and vomiting. The pharmaceutical Journal; online

 

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