Postoperative nausea and vomiting are among the most common symptoms that accompany surgical procedures. They are caused by anesthesia.
What is postoperative nausea and vomiting?
Medicine also refers to side effects such as postoperative nausea and vomiting as PONV for short. This abbreviation stands for the English term postoperative nausea and vomiting. It refers to the occurrence of nausea and vomiting following a surgical procedure. Overall, about one in three patients suffers from postoperative nausea and vomiting. This side effect is primarily seen with anesthesia methods such as general anesthesia or regional anesthesia. However, multimodal therapy concepts offer the possibility of effectively counteracting PONV.
Causes
What causes postoperative nausea and vomiting is not yet completely clear. However, in recent years, different risk factors for the occurrence of these unpleasant side effects could be determined. Nausea or vomiting is triggered by stimulation of the vomiting center, which is located within the medulla oblangata. This brain region is located at the back of the central nervous system (CNS). It is a protective reflex by which the organism acts against the substances ingested during anesthesia, which serve to anesthetize the patient. Thus, the body of the affected person registers the substances as toxins. Also of importance in the transmission of neural impulses are messenger substances such as serotonin, dopamine, acetylcholine and histamine. However, the exact pathological processes of PONV could not be determined so far. Among the various risk factors, the female gender is particularly important. Thus, the risk of suffering from nausea and vomiting after surgery is considered to be twice as high in women as in men. From a pathophysiological point of view, there is no explanation for this. Non-smokers are also affected by postoperative nausea and vomiting twice as often as people who smoke. It is suspected that this is related to changes in dopamine receptors. Also considered risk factors are a history of PONV and motion sickness. Therefore, individual factors are assumed for the occurrence of postoperative nausea and vomiting. Only rarely does PONV present in babies and young children. It is slightly more common in children who are between 6 and 16 years of age. Other possible components of PONV are also hotly debated in the medical community. These are the length of anesthesia, the use of nitrous oxide, inhalational anesthetics, and the administration of opioids after surgery. Also under debate are mask ventilation, the use of gastric tubes, the body mass index, psychological factors and the female menstrual cycle. However, the study situation is still too imprecise for this.
Symptoms, complaints, and signs
PONV is noticeable by the onset of severe nausea and nausea. In most cases, the patient also has to vomit. The general condition of the affected person is considerably limited by postoperative nausea and vomiting. If there is no sufficient protective reflex, there is a risk that gastric juice will be inhaled. This in turn can lead to Mendelson syndrome. In addition, airway obstruction is possible. If vomiting occurs repeatedly, there is a risk of disturbances within the electrolyte balance. Occasionally, ruptures of the esophagus or trachea may also occur.
Diagnosis and course of the disease
The diagnosis of postoperative nausea and vomiting is not difficult. For example, the physician can quickly determine it based on the typical symptoms. In addition, the symptoms occur immediately after a surgical procedure. In addition, risk factors also play an important role. PONV usually resolves on its own and lasts for about 24 hours. However, the patient’s well-being is severely affected during this period. Therefore, postoperative nausea and vomiting are among the most serious problems associated with anesthesia. Thus, it is not uncommon for the patient to be more distressed by nausea and vomiting than by wound pain. Furthermore, the affected individuals feel more anxiety about the procedure. In pronounced cases, the complications can be so great that a longer stay in the hospital is necessary for the patient.
Complications
Postoperative nausea and vomiting play a major role in everyday hospital life and, in a few cases, bring about serious complications. Nevertheless, in rare cases, the general malaise of patients who have undergone surgery causes them to suffer more from nausea than from the consequences of surgery (wound pain, for example). Thus, in the worst case, hospitalization may have to be prolonged due to ruptured scars – in the case of cramps resulting from vomiting. Severely immobile patients also have a certain risk of choking on vomit. In this respect, permanent monitoring becomes necessary in their case. This applies, for example, to patients with multiple sclerosis or advanced dementia. In addition, breathing problems may occur in rare cases. Skin irritations also occur. Due to the fact that food intake is often reduced in cases of prolonged nausea, patients do not recover satisfactorily in some cases. However, this depends on what diseases are present, how severe the surgery was, and how the patient is generally nourished. In addition, knowledge of postoperative nausea can fuel anxiety in people who are scheduled for surgery, leading to psychological distress before and after surgery.
When should you see a doctor?
Postoperative nausea and vomiting is a phenomenon that affects 20 to 30 percent of all people. Medical treatment is necessary if the symptoms persist for more than a few hours or rapidly become more severe. Patients who are still in the hospital while PONV occurs should inform the appropriate physician. Further treatment is necessary if the postoperative syndrome has a very negative effect on well-being or occurs in conjunction with other complaints. For example, a physician should definitely be consulted if fever, shortness of breath, skin irritation or other gastrointestinal complaints occur in addition to PONV. Women are particularly at risk. Non-smokers and people who have previously experienced PONV or motion sickness are also at risk and should inform their physician immediately. Postoperative nausea and vomiting is treated by the primary care physician or a gastroenterologist. If the syndrome occurs in the hospital, the attending nurse should be informed of the discomfort. Subsequently, the discomfort can be reduced by a change in medication.
Treatment and therapy
To treat postoperative nausea and vomiting, the administration of antiemetics is possible. These are drugs that reduce nausea. These include the corticosteroid dexamethasone, which is also suitable for combination with other agents, the neuroleptic droperidol, which belongs to the butyrophenone group and acts on the dopamine receptor D2, and 5HT3 antagonists, which block 5HT3 receptors. Other effective antiemetics include metoclopramide, which belongs to the benzamide group and acts at the histamine, serotonin, and dopamine receptors, the antihistamine dimenhydrinate, and neurokinin antagonists. Also important in the treatment of PONV are modifications of the anesthetic procedure. For example, in some cases, regional anesthesia, which is less likely to cause nausea and vomiting, can be used as an alternative. It is also considered useful to avoid inhalation anesthetics. If the patient suffers from Mendelson’s syndrome, intensive medical therapy is administered. This includes intubation, artificial respiration and the administration of oxygen. Furthermore, glucocorticoids, antibiotics, or bronchospasmolytics are administered.
Prevention
To prevent postoperative nausea and vomiting from the beginning, the patient receives dexamethasone at the start of surgery. Antiemetics such as dimenhydrinate, droperidol, and setrone also have a preventive effect. Total intravenous anesthesia (TIVA) is considered an alternative to the administration of inhalation anesthetics. Furthermore, the risk of PONV can be reduced by performing regional anesthesia. Efficient risk reduction can be achieved by combining these procedures.
Follow-up
Nausea and vomiting are among the most common side effects after surgery under general anesthesia. Intensive medical monitoring after surgery is common. For this reason, there is no question about follow-up care, because it occurs as part of this close monitoring. Patients who have undergone surgery are physically weakened after general anesthesia.In the event of postoperative vomiting, the vomit may be swallowed and enter the trachea. Follow-up care is therefore necessary to avoid such sequelae. Too frequent vomiting puts a strain on the electrolyte balance. It is monitored during follow-up care. If necessary, the patient receives fluid on a drip to prevent circulatory collapse. The severity of postoperative symptoms depends on the patient’s physical condition, age, and the severity of the procedure. If the patient suffers from unusually severe nausea despite a stable general condition and a mild operation, the cause is investigated during follow-up checks. A different medication or an increased dose may counteract the symptoms. If the cause is in another area, the attending physician or anesthesiologist is consulted. He or she will initiate further investigations or refer the patient to another ward.
What you can do yourself
This is the common result of anesthesia, which affects women twice as often as men. For patients, it is certainly comforting to know that this condition, although extremely unpleasant, is not permanent. As a rule, the nausea is gone by the next day. However, during this time, patients must be careful not to inhale vomit and gastric juice, as complications could arise. If the patient vomits violently several times, it can also lead to tears in the esophagus. Therefore, it is important that patients tell the nursing staff or doctors that they are suffering from postoperative nausea. Then they can be monitored by clinic staff. This is especially true if they are unable to move due to the surgery and thus are unable to help themselves. Despite the nausea, it is important that patients consume sufficient fluids to compensate for the deficits that have occurred. This also applies to the next day, when the nausea has passed but the patient did not eat and drink enough the day before. To recover after surgery, it is important to consume sufficient nutrients. This is best accomplished through fresh juices, nutritious soups and broths, and gruel or porridge if the patient is not yet able to eat a normal diet.
