Management of vomiting and nausea after surgery

Article by Specialist I Tran Thi Anh Hien - Anesthesiologist - Anesthesiology Department - Vinmec Central Park International Hospital

Vomiting and nausea are one of the common complications in postoperative patients. According to statistics from the American Society of Anesthesiology, about 20 to 30% of patients experience vomiting and nausea within 24 hours of surgery, this rate increases to 80% in high-risk patients.
Vomiting and nausea after surgery, if not well controlled, can affect the patient's psychology and surgical results, and can cause some complications such as electrolyte and water disorders, or pneumonia. due to aspiration of vomit from the stomach (Mendelson's syndrome).
Prophylaxis as well as treatment of vomiting and nausea after surgery is an issue of great interest in improving the quality of care and treatment of patients after surgery. The use of prophylactic antiemetics should be based on an assessment of the patient's risk of postoperative nausea and vomiting. However, there is no single scale that can accurately predict the risk of postoperative nausea and vomiting for a patient, but only allows clinicians to estimate risk across patient groups.

Author Apfel used the following 4 factors to assess the risk of nausea and vomiting after surgery. Each risk factor is counted as 1 point. The more predictive factors, the higher the risk of vomiting and nausea after surgery. Factors included:
Women who do not smoke, Motion sickness or history of vomiting and nausea after surgery Morphine use during and after surgery Apfel transcripts

Using the Eberhart scale:
3 years of age History of nausea and vomiting after surgery by self, parents or siblings Double eyelid surgery Surgery time 30 minutes

In addition, the British Association of Pediatric Anesthesia has introduced the concept of "emetic surgery": tonsillectomy and VA curettage, middle ear surgery.

Recommended strategies to reduce the risk of postoperative nausea and vomiting include:
Assess whether regional anesthesia can be used as an alternative to anesthesia If anaesthesia: Empty the stomach before surgery; intravenous injection of Ranitidine 2 mg/kg 45 minutes before induction of anesthesia; give the patient 100% oxygen for 3 minutes before induction of anesthesia; induction and maintenance of anesthesia with PROPOFOL; reduce the concentration of volatile anesthetics, do not use N2O; Minimize the use of OPIOID during and after surgery.

Prophylaxis of postoperative nausea and vomiting:
Low risk: no drug Moderate risk: Ondansetron + Dexamethasone High risk: Ondansetron + Dexamethasone + intravenous anesthesia Rescue therapy: Metoclopramide, Droperidol