Complications
Since immediately after general anesthesia the protective reflexes, especially the swallowing and coughing reflex, have not yet fully returned, vomit can be swallowed and enter the lungs. The acidic stomach contents can damage the lung tissue, obstruct the airways and trigger pneumonia. The increase in pressure in the abdominal cavity during vomiting can cause sutured wounds to burst open and cause severe bleeding. Repeated vomiting can also lead to a disturbance in the electrolyte balance. You can read more about pneumonia here.
What is the PONV score?
The apple score is often used for preoperative risk assessment. It covers four risk factors: female gender, non-smoking, known motion sickness or known postoperative nausea and the expected administration of opioid painkillers. One point is awarded for each factor.
Accordingly, the probability of PONV is approximately 10% for 0 points, 20% for 1 point, 40% for 2 points, 60% for 3 points and 80% for 4 points. However, the apple score can only be used for adults. For children there is a correspondingly adjusted POVOC score. It includes factors such as surgery duration ≥ 30 minutes, age ≥ 3 years, strabismus surgery, adenotomy/tonsillotomy, anamnesis for PONV/travelling sickness in children or siblings, parents.
The diagnosis
The diagnosis can definitely only be made after the first general anesthesia. Affected patients complain of nausea after the operation and have to vomit despite an empty stomach.You are pale, cold sweaty and your well-being is severely limited
The treatment
The treatment of PONV involves the administration of antiemetics, i.e. drugs that act centrally in the brain at the nausea center or in the periphery to suppress nausea and vomiting. The following drugs are available: Dexamethasone is used as the drug of choice, mainly for prophylaxis and as a supplement to other antiemetics at an early stage. Drugs from the group of “setrons” are highly effective; they block the serotonin receptors in the nausea center.
Side effects can include headaches and constipation. Another very common drug is metoclopramide (MCP/Paspertine), the most common side effect is a drop in blood pressure. As a last step, the neuroleptic drug droperidol can be administered, it acts on the dopamine receptor and can cause severe side effects, so strict control must be carried out intra- and postoperatively.
As complementary measures acupuncture or inhalation of aromatic substances can be used. If PONV occurs despite prophylaxis, the same medication should not be given again postoperatively, but an alternative should be used. If complications occur in the course of PONV, such as aspiration of vomit, antibiotics and intensive care therapy must be started immediately.