Surgery vomiting after

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. 

Transdermal scopolamine (hyoscine) was introduced in the 1980s as a convenient alternative for the prevention of motion sickness. It is also effective in reducing of nausea and vomiting after ear surgery but was not found to be useful in the prevention of vasovagal syncope (see Chapter 14). 

Karlsson E, Larsson LE, Nilsson K. The effects of prophylactic dixyrazine on postoperative vomiting after two different anaesthetic methods for squint surgery in children. Acta Anaesthesiol Scand 1993 37(l) 45-8. 

The effect of tramadol on postoperative nausea and vomiting after ENT surgery has been studied in a prospective, randomized, double-blind comparison with... 

Oh AY, Kim JH, Hwang JW, Do SH, Jeon YT. Incidence of postoperative nausea and vomiting after paediatric strabismus surgery with sevoflurane or remifentanil-sevoflurane. Br J Anaesth 2010 104(6) 756-60. 

Choi YS, Shim JK, Yoon DH, Jeon DH, Lee JY, Kwak YL. Effect of ramosetron on patient-controlled analgesia related nausea and vomiting after spine surgery in highly susceptible patients comparison with ondansetron. Spine 2008 33(17) E602-6. 

Comparative studies Azasetron versus ondansetron Intravenous azasetron 10 mg and ondansetron 8 mg have been compared in a double-blind, randomized trial in 98 patients with postoperative nausea and vomiting after gynecological laparoscopic surgery under general anesthesia [23 "]. Azasetron was more efficacious in the intermediate postoperative period (12-24 hours). Both drugs caused headache, dizziness, and constipation and the frequencies were similar. 

Overall survival is affected by the success of the initial surgery to debulk the tumor to less than 1 cm of disease and response to first-line chemotherapy. The CA-125 level should be monitored with each cycle, and at least a 50% reduction in CA-125 after four cycles of taxane/platinum chemotherapy is related to an improved prognosis. Patients who achieve a complete response should have follow-up examinations every 3 months, including CA-125 determination, physical examination, pelvic examination, and appropriate diagnostic scans (e.g., CT scan, MRI, or PET scan) and should be evaluated for the detection of disease. Evaluate patients for resolution of any residual chemotherapy-related side effects, including neuropathies, nephrotoxicity, ototoxicity, myelosuppression, and nausea/vomiting. 

Parenteral Immediately before induction of anesthesia, or postoperatively if the patient experiences nausea or vomiting shortly after surgery, administer 4 mg undiluted IV in not less than 30 seconds, preferably over 2 to 5 minutes. Alternatively, 4 mg undiluted may be administered IM as a single injection in adults. In patients who do not achieve adequate control, administration of a second IV dose of 4 mg ondansetron postoperatively does not provide additional control of nausea and vomiting. 

Postoperative nausea or vomiting Transdermal 1 system no sooner than 1 hr before surgery and removed 24 hr after surgery. 

Relief of pain after surgery can be achieved with a variety of techniques. An epidural infusion of a mixture of local anaesthetic and opioid provides excellent pain relief after major surgery such as laparotomy. Parenteral morphine, given intermittently by a nurse or by a patient-controlled system, will also relieve moderate or severe pain but has the attendant risk of nausea, vomiting, sedation and respiratory depression. The addition of regular paracetamol and a NSAID, given orally or rectally, will provide additional pain relief and reduce the requirement for morphine. NSAIDs are contraindicated if there is a history of gastrointestinal ulceration of if renal blood flow is compromised. 

Postoperative nausea and vomiting (PONV) is common after laparotomy and major gynaecological surgery, e.g., abdominal hysterectomy The use of propofol, particularly when given to maintain anaesthesia, has dramatically reduced the incidence of PONV. Antiemetics, such as cyclizine, metoclo-pramide, and ondansetron, may be helpful. 

Nelskyla KA, Yh-Hankala AM, Puro PH, Korttila KT. Sevoflurane titration using bispectral index decreases postoperative vomiting in phase II recovery after ambulatory surgery. Anesth Analg 2001 93(5) 1165-9. 

In a retrospective review of 37 patients with chronic non-malignant pain (mostly from failed lumbosacral spine surgery) treated with intrathecal hydromorphone there was an analgesic response in six of the 16 patients who were switched from morphine to hydromorphone because of poor pain relief (1). Opioid-related adverse effects, such as nausea, vomiting, pruritus, and sedation, were also reduced by hydromorphone in the 21 patients who were switched to hydromorphone because of morphine-related adverse effects, especially 1 month after use. These results should be treated cautiously, because of the limitations of a retrospective study that lacks strict inclusion criteria, with obvious population bias and under-reporting, and without standardized procedures for rotation to hydromorphone. 

An epidural infusion of 0.2% ropivacaine plus sufentanil has been compared with 0.175% bupivacaine plus sufentanil in 86 patients postoperatively after major gastrointestinal surgery there was no statistically significant difference in the incidence of adverse effects (respiratory depression, sedation, nausea, vomiting, pruritus, and motor blockade), but those given ropivacaine mobilized more quickly (114). 

There have been another two studies of the analgesic effect of intrathecal morphine in children (34,35). In a prospective, double-blind study, 30 children (aged 9-19 years) scheduled for spinal fusion were randomly allocated to a single dose of saline or intrathecal morphine 2 or 5 pg/kg after surgery, a PCA device provided access to additional intravenous morphine (34). The doses of 2 and 5 pg/kg had similar analgesic effectiveness and adverse effects profiles (nausea, vomiting, pruritus). There were no episodes of severe respiratory depression. Low-dose intrathecal morphine supplemented with PCA morphine provides better analgesia than PCA morphine alone. 

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