The most common side effects after surgical interventions include postoperative nausea and vomiting. They are caused by the 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. This refers to the occurrence of nausea and vomiting following a surgical procedure.
Overall, about every third patient suffers from postoperative nausea and vomiting. This side effect is primarily seen with anesthesia methods such as general or regional anesthesia. However, multimodal therapy concepts make it possible to effectively counteract PONV. See howsmb for Dislocation Definition and Meaning.
What causes postoperative nausea and vomiting is not fully understood. However, in recent years, different risk factors for the occurrence of these unpleasant side effects have been identified. Nausea or vomiting is triggered by stimulating the vomiting center, which is located within the medulla oblangata.
This brain region is located at the back of the central nervous system (CNS). This is a protective reflex, through which the body acts against the substances absorbed during anesthesia, which serve to numb the patient. The body of the person concerned registers the substances as toxins.
Messenger substances such as serotonin, dopamine, acetylcholine and histamine are also important in the transmission of neural impulses. However, the exact pathological processes of PONV have not yet been determined. Female gender is one of the various risk factors. The risk of suffering from nausea and vomiting after an operation is twice as high in women as in men.
There is no explanation for this from a pathophysiological point of view. Non-smokers are also twice as likely to be affected by postoperative nausea and vomiting as people who smoke. It is assumed that there is a connection with changes in the dopamine receptors. PONV that has already occurred in the past and motion sickness are also considered risk factors. Therefore, individual factors are assumed to be responsible for the development of postoperative nausea and vomiting.
PONV is rare in babies and young children. It is slightly more common in children between the ages of 6 and 16. Other possible components of PONV are also hotly debated in medicine. These include the length of the anesthesia, the use of nitrous oxide, inhalational anesthetics and the administration of opioids after the operation.
Mask ventilation, the use of gastric tubes, the body mass index, psychological factors and the female menstrual cycle are also under debate. However, the study situation is still too imprecise for this.
Symptoms, Ailments & Signs
PONV becomes noticeable through the occurrence of severe nausea and vomiting. In most cases, the patient also throws up. The general condition of those affected is significantly reduced by postoperative nausea and vomiting. If there is not a sufficient protective reflex, there is a risk that gastric juice will be inhaled.
This in turn can lead to Mendelson syndrome. In addition, an obstruction of the airways is possible. If the vomiting occurs repeatedly, there is a risk of disturbances within the electrolyte balance. Occasionally tears can also occur in the esophagus or trachea.
Diagnosis & course of disease
Diagnosing postoperative nausea and vomiting is not difficult. In this way, the doctor can quickly identify them based on the typical symptoms. In addition, the symptoms appear immediately after a surgical intervention. In addition, risk factors also play an important role. PONV usually goes away on its own and lasts about 24 hours.
However, the well-being of the patient is severely affected during this period. Therefore, postoperative nausea and vomiting are among the most serious problems in anesthesia. It is not uncommon for the patient to be more distressed by nausea and vomiting than by wound pain. Furthermore, the affected persons feel more afraid of the procedure. In severe cases, the complications can be so great that a longer stay in the hospital is necessary for the patient.
Postoperative nausea and vomiting play a major role in everyday clinical practice and in a few cases lead to serious complications. However, in rare cases, the general feeling of being unwell in operated patients means that they suffer more from the nausea than from the consequences of the operation (soreness, for example). In the worst case, the hospital stay may have to be extended due to torn 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 is necessary for them. This applies, for example, to patients with multiple sclerosis or advanced dementia. In rare cases, breathing problems can also occur. Skin irritation also occurs.
Because food intake is often reduced when nausea persists for a long time, in some cases patients do not recover satisfactorily. However, this depends on what diseases are present, how serious the operation was and how the patient is generally nourished. Knowing about postoperative nausea can also fuel anxiety in people who have an operation appointment, which leads to psychological stress before and after the operation.
When should you go to the 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 get worse quickly. Patients who remain in the hospital while PONV occurs should inform the attending physician. Further treatment is necessary if the postoperative syndrome has a very negative effect on well-being or occurs in connection with other complaints.
A doctor should definitely be consulted if, in addition to PONV, there is fever, shortness of breath, skin irritation or other gastrointestinal complaints. Women are particularly at risk. Non-smokers and people who have already experienced PONV or motion sickness are also among the risk groups and should inform their doctor immediately. Post- surgical nausea and vomiting is treated by your family doctor or a gastroenterologist. If the syndrome occurs in the clinic, the nurses present should be informed of the symptoms. The symptoms can then be reduced by changing the medication.
Treatment & Therapy
Antiemetics can be administered to treat postoperative nausea and vomiting. These are drugs that reduce nausea. These include the corticosteroid dexamethasone, which is also suitable for combination with other active ingredients, the neuroleptic droperidol, which comes from the group of butyrophenones and acts on the dopamine receptor D2, and 5HT3 antagonists, which block 5HT3 receptors.
Other effective antiemetics are metoclopramide, which belongs to the benzamide group and acts on the histamine, serotonin and dopamine receptors, the antihistamine dimenhydrinate and neurokinin antagonists. Modifications to the anesthetic procedure are also important in the management of PONV.
In some cases, regional anesthesia can be used as an alternative, which causes nausea and vomiting less frequently. It also makes sense to avoid using inhalation anesthetics. If the patient suffers from Mendelson’s syndrome, intensive care therapy is carried out. This includes intubation, artificial respiration and the administration of oxygen. Furthermore, glucocorticoids, antibiotics or bronchospasmolytics are administered.
In order to prevent postoperative nausea and vomiting from the outset, the patient is given dexamethasone at the beginning of the operation. 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 PONV risk can be reduced by performing regional anesthesia. Efficient risk reduction can be achieved through a combination of these methods.
Nausea and vomiting are among the most common side effects after surgery under general anesthesia. Intensive medical monitoring after an operation is common practice. For this reason, there is no question about aftercare, because it takes place within the framework of this close-meshed control.
Operated patients are physically weakened after general anesthesia. With postoperative vomiting, the vomit can be swallowed and enter the trachea. Follow-up care is therefore necessary to avoid such side effects. Excessive vomiting puts a strain on the electrolyte balance. He will be monitored during follow-up treatment. If necessary, the patient receives liquid on a drip to prevent a circulatory collapse.
The severity of postoperative symptoms depends on the patient’s physical condition, age and the severity of the operation. If the person concerned suffers from unusually strong nausea despite a stable general condition and a minor operation, the cause is investigated during the follow-up checks. Another drug or an increased dose can counteract the symptoms. If the cause lies in another area, the attending doctor or anesthesiologist will be consulted. He initiates further examinations or transfers the patient to another ward.
You can do that yourself
This is the common consequence of anesthesia, which affects women twice as often as men. It is certainly reassuring for patients to know that this condition, while extremely uncomfortable, is not permanent. The nausea is usually gone by the next day.
However, those affected must ensure that they do not inhale vomit and gastric juice during this time, as this could lead to complications. If the patient vomits violently several times, tears in the esophagus can also occur. 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 the clinic staff. This applies in particular if the person concerned is unable to move as a result of the procedure and is therefore unable to help themselves.
Despite the nausea, it is important that patients drink enough fluids to compensate for the deficits that have arisen. This also applies to the next day when the nausea is over but the patient ate and drank too little the day before. In order to recover after an operation, it is important to eat enough nutrients. The best way to do this is with fresh juices, nutritious soups and broths, and gruel or porridge if the patient is not yet able to eat a normal diet.