Postoperative nausea

Gan TJ, Meyer T, Apfel CC et al (2003) Consensus guidelines for managing postoperative nausea and vomiting. Anesth Analg 97 62-71... 

Wallenborn J, Gelbrich G, Bulst D et al (2006) Prevention of postoperative nausea and vomiting by metoclopramide combined with dexamethasone randomised double blind multicentre trial. Br Med J 333 324-327... 

This type of pain management is used for postoperative pain, labor pain, and cancer pain. The most serious adverse reaction associated with the administration of narcotics by the epidural route is respiratory depression. The patient may also experience sedation, confusion, nausea, pruritus, or urinary retention. Fentanyl is increasingly used as an alternative to morphine sulfate because patients experience fewer adverse reactions. 

Antiemetic—to lessen the incidence of nausea and vomiting during the immediate postoperative recovery period. 

Pulmonary disease, small-cell lung cancer, head trauma, stroke, central nervous system infections, pituitary surgery, prolactinoma, severe nausea, psychiatric disease, and postoperative state... 

Droperidol or a 5-HT3 receptor antagonist should be administered at the end of surgery to patients at high risk for developing postoperative nausea and vomiting. 

CINV, chemotherapy-induced nausea and vomiting PONV, postoperative nausea and vomiting. 

Gan TJ, Meyer T, Apfel CC, et al. Consensus guidelines for managing postoperative nausea and vomiting. Anesth Analg 2003 97 62-71. Gralla RJ, Osoba D, Kris MG, et al. Recommendations for the use of antiemetics evidence based clinical practice guidelines. J Clin Oncol 1999 17 2971-2994. 

Dexamethasone has been used successfully in the management of chemotherapy-induced nausea and vomiting (CINV) and postoperative nausea and vomiting (PONV), either as a single agent or in combination with selective serotonin reuptake inhibitors (SSRIs). For CINV, dexamethasone is effective in the prevention of both cisplatin-induced acute emesis and when used alone or in combination for the prevention of delayed nausea and vomiting associated with CINV. 

Key - Ineffective, + Effective, CD Crossover design, DB Double blind, GA General anesthesia (postoperative nausea), HG Hyperemesis gravidarum,... 

Arfeen Z, Owen H, Plummer JL, Ilsley AH, Sorby-Adams RA, Doecke G. (1995). A double-blind randomized controlled trial of ginger for the prevention of postoperative nausea and vomiting. Anaesth Intensive Care. 23(4) 449-52. 

Bone ME, Wilkinson DJ, Young JR, McNeil J, Charlton S. (1990). Ginger root—a new antiemetic. The effect of ginger root on postoperative nausea and vomiting after major gynaecological surgery. Anaesthesia. 45(8) 669-71. 

Koivuranta M, Laara E, Ranta P, Ravaska P, Alahuhta S. (1997). Comparison of ondansetron and droperidol in the prevention of postoperative nausea and vomiting after laparoscopic surgery in women. A randomised, double-blind, placebo-controlled trial. Acta Anaesthesiol Scand. 41(10) 1273-9. 

Visalyaputra S, Petchpaisit N, Somcharoen K, Choavaratana R. (1998). The efficacy of ginger root in the prevention of postoperative nausea and vomiting after outpatient gynaecological laparoscopy. Anaesthesia. 53(5) 506-10. 

Ondansetron is a 5HT3 antagonist, blocking serotonin receptors in the central nervous system and the gastrointestinal tract. It is useful in the management of postoperative nausea and vomiting associated with cytotoxics. 

Adverse reactions occurring in at least 3% of patients include nausea vomiting tachycardia hypertension postoperative pain fever dizziness. 

Promethazine Promethazine also is indicated for preoperative, postoperative, or obstetric sedation prevention and control of nausea and vomiting associated with certain types of anesthesia and surgery an adjunct to analgesics for control of postoperative pain sedation and relief of apprehension, and to produce light sleep antiemetic effect in postoperative patients active and prophylactic treatment of motion sickness (oral and rectal only). 

Nausea and vomiting 12.5 to 25 mg do not repeat more frequently than every 4 hours. For postoperative nausea and vomiting, administer IM or IV. 

Initiation of therapy - App y one system to the postauricular skin (ie, behind the ear) at least 4 hours before the antiemetic effect is required. To prevent postoperative nausea and vomiting, apply the patch the evening before scheduled surgery. To minimize exposure of the newborn baby to the drug, apply the patch 1 hour prior to cesarean section. Scopolamine approximately 1 mg will be delivered over 3 days. Wear only one disc at a time. Do not cut the patch. 

For the treatment of postoperative nausea and vomiting and for nausea associated with gastroenteritis. 

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