Post Operative Nausea

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Post Operative Nausea Vomiting

• Dr.M.Kannan MD DA
• Professor And HOD
• Department of Anaesthesiology
• Tirunelveli Medical College

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Post Operative Nausea Vomiting
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Regurgitation

• Passive process

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Lower Oesophageal Sphincter

• Oesophageal Smooth muscle-intrinsic sphincter
• Crural fibers of the Diaphragm extrinsic
  sphincter
• Oblique fibres of the Stomach

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Gastric Emptying

• Gastric Emptying Time Adult- 5 to 6 hours
• Prolonged Solid food,Fats
• Reduced- Liquid food
• Peadiatric time-4h
• Infant-3h
• New Born-2h

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Factors Associated with PONV

• Patient Factor
• Surgical Factor
• Anaesthetic Factor

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Patient Factor -PONV

• Children
• Women
• Full Stomach
• Hiatus Hernia
• Gastric outlet Obstruction

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Surgical Factor-PONV

• Type of Surgery
• -Gynaecological
• -ENT
• -Squint Surgery
• -Gastrointestinal
• Duration of Surgery
• Antibiotics

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Anaesthetic Factor-PNOV

• Opiods
• Volatile Agents
• Postoperative Pain
• Hypotension Spinal/Epidural
• Experience of Anaesthesiologist

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Adverse Effect of PONV
Real Danger

• Patient Distress
• Aspiration of Stomach content
• Poor Surgical Outcome ?
• Intra cranial pressure
• Intraocular pressure
• Intra thoracic pressure
• Intra abdominal pressure
• Violent peristalsis

• Neurosursery
• Opthalmic surgery
• Head Neck surgery
• Abdominal wound
• Oesophageal Surgery

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Mendelsons Syndrome

• Aspiration Pneumonities
• Pathophysiological Canges
• -Atelectasis
• -Alveolar Oedema
• -Loss of Surfactant
• -Pulmonary Oedema

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Pathophysiological Changes

• Intrapulmonry Shunting
• Hypoxia
• Hypocapnia
• Hypercapnia
• Pulmonary Hypertesion

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Symptoms

• In drawing of intercostal space
• Wheezing
• Tachycardia
• Tachypnia

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Prevention

• Head down Position Neck turned to one side

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Prevention

• Fasting
• Empty the Stomach
• Reduce the volume Metclopramide
• Reduce the acidity-Sodium Citrate
• -H2blockers-Ranitidine
• Central acting -Ondesetron

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Metclopramide

• Acts on Dopamine receptor StomachCTZ
• Gastric emptying time
• Lower Oesophageal tone
• Dose 10mg IV or IM
• Effect 1-3min

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Ranitidine

• H2 Receptor antogonist
• Reduces Acidity
• Dose 50mg IV-1-2hours

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Ondansetron

• 5 HT3 Receptor Antagonist
• Stomach CNS
• Dose 4 mg IV-10 -15 min

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Prevention

• Suction of the Pharyngeal content

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Prevention-Regurgitation

• Sellicks Maneuver

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Sellicks Maneuver
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Intubation
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Rapid-Sequence Induction

• Tendelenberg Position Suction Apparatus
• Pre-Oxygenate 3-5Min
• Prior curarization
• Sellicks maneuver
• Thiopentone IV
• Succinylcholine IV
• Quick Intubation
• Extubation after full recovery

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Treatment

• Pharyngeal Suction
• Intubation
• Broncheal lavage
• Positive Pressure Ventilation
• Bronchodilators