The incidence of postoperative nausea and vomiting in
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The incidence of postoperative nausea and vomiting in

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There is acorrelation between the GA and phase of menstruation. Proven with a studyby Dr.Mridul Panditrao and his team.

There is acorrelation between the GA and phase of menstruation. Proven with a studyby Dr.Mridul Panditrao and his team.

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  • 1. Anaesthesiology THE INCIDENCE OF POSTOPERATIVE NAUSEA AND VOMITING IN WOMEN UNDERGOING SURGERIES UNDER GENERAL ANAESTHESIA DURING DIFFERENT PHASES OF MENSTRUAL CYCLE Presenting author DR ADITI PANDITRAO Co authors Dr (Mrs) MM PANDITRAO Dr. IMRAN AZHER Dr MM PANDITRAO
  • 2. Anaesthesiology1. INTRODUCTION2. AIM AND OBJECTIVES3. MATERIAL AND METHODS4. DISCUISSIONS5. RESULTS6. CONCLUSION
  • 3. Anaesthesiology 27 Dec2008 INTRODUCTIONETIOLOGICAL FACTORS PATIENT RELATED FACTORS Age Gender obesity H/O previous PONV Anxiety Smokers PREOPERATIVE FACTORS Food Phsycological stress PERIOPERATIVE FACTORS Pre medication Gastric distention and suctioning Pharyngeal stimulation by supraglottic devices.
  • 4. AnaesthesiologyINTRAOPERATIVE FACTORS Anaesthetic factors- IV anaesthetic agents Inhalational agents Surgical factors- duration Type of surgeryPOSTOPRERATIVE FACTORS Pain Dizziness Ambulation Oral intake
  • 5. Anaesthesiology AIM AND OBJECTIVES1. To find out the incidence of PONV during different phases of menstrual cycle in patients undergoing surgeries under general anaesthesia.2. To compare the two if there is any difference.
  • 6. Anaesthesiology MATERIALS AND METHODS• Approval of the institutional ethical committee.• 60 ASA I and II patients.• Normal menstrual cycle.• Age between 18-45 years.• Elective surgery under GA, duration of surgery 30 min- 3 hrs.• Depending on date of LMP, classified as MENSTRUAL GROUP (day 1-8) NON MENSTRUAL GROUP ( day 9-28) EXCLUSION CRITERIA• HO hypertensive or cardiovascular disease.• HO allergic to anaesthetic drugs.• Post menopausal, pregnant patients and patients with menstrual disturbances.
  • 7. AnaesthesiologyPREANAESTHETIC EVALUATION Pre op check up Vitals LMPPREANAESTHETIC MEDICATION inj Atropine .6mg iv inj Fentanyl 2mics/kg or inj Butorphanol 1mg iv inj midazolam 1mg iv
  • 8. AnaesthesiologyINDUCTION AND MAINTAINENCE . Preoxygenation 100% oxygen . Thiopentone (titrated to loss of eyelash reflex). . Succinylcholine 2mg/kg body wt. . Laryngoscopy and intubation. . Muscle relaxation inj vecuronium .08mg/kg iv or injrocuronium .6mg/kg iv . Maintainence on O2 33% , N2O 66% and isoflurane upto 1%. . Monitoring of vitals, urine output and blood loss. EXTUBATION .Reversal with inj atropine .02 mg/kg and neostigmine.05mg/kg.
  • 9. AnaesthesiologyNAUSEA AND VOMITING SCORE 0 – No nausea 1 – Mild nausea 2 – Moderate nausea 3 – Severe nausea 4 – Retching/ VomitingSEDATION SCORE 1 – Sleepy but not arousable 2 – Sleepy but arousable. 3 – Drowsy. 4 – Awake.
  • 10. AnaesthesiologyVAS SCALE 0 3 5 7 10 0-3 Mild pain 4-7 Moderate pain > 7 Severe pain RESCUE ANTIEMETICS AND ANALGESIC inj Ondansetron 4 mg iv inj Diclofenac 1mg/kg im.
  • 11. Anaesthesiology OBSERVATION AND RESULTSGROUP NO OF % OF PATIENTS PATIENTSMENSTRUAL 17 29NON MENSTRUAL 43 71TOTAL 60 100
  • 12. AnaesthesiologyPIE DIAGRAM SHOWING DISTRIBUTION OF CASES IN BOTH THE GROUPS Menst 29% rual Nonm71% enstru al
  • 13. Anaesthesiology COMPARISION OF DEMOGRAPHIC PROFILEPARTICULAR MENSTRUATION NON t p MENSTRUATION VALUE VALUE AGE 27.53 9.07 .026 >0.05 26.91 6.55 WEIGHT 50.76 8.79 52.91 12.34 .03 >0.05DURATION 77.94 26.28 78.14 37.48 .02 >0.05OF SURGERY P value >0.05 is not statstically significant.
  • 14. AnaesthesiologyNO STATISTICAL SIGNIFICANCE IN BOTH THE GROUPS Demographic profile Duration of surgery Vital parameters.OVERALL INCIDENCE OF PONV MENSTRUAL PERIOD – 70.5% NON MENSTRUAL PERIOD – 36%.The incidence of PONV was increased in the menstrual group at about 30min 90 min, 6hrs and 12 hrs but it was statstically significant at only about 12hrs.NO STATISTICAL SIGNIFICANCE IN BOTH THE GROUPS Sedation score VAS score
  • 15. Anaesthesiology COMPARISION OF NAUSEA VOMITING SCORE IN STUDY GROUPSTIME MENSTRUAL POST MENSTRUAL T P Mean SD(n=17) Mean SD(n=43)30 min 0.59 1.33 0.21 0.77 1.10 >0.0560 min 0.94 1.25 0.53 1.12 1.17 >0.0590 min 1.35 1.58 0.53 1.24 1.91 >0.05120 min 0.71 1.36 0.30 0.83 1.14 >0.056 hrs 1.06 1.43 0.42 1.12 1.65 >0.0512 hrs 1.18 1.70 0.09 0.37 2.60 <0.0124 hrs 0.06 0.24 0 0 1 > 0.05
  • 16. Anaesthesiology •
  • 17. Anaesthesiology• DISCUSSION• SECOND MOST COMMON COMPLAINT POST OP PATIENTS.• DETERMINES THE LENGHTH OF HOSPITAL STAY.• INFLUENCED BY MENSTRUAL CYCLE.• HORMONAL INFLUENCES MOSTLY ESTROGENIC.• HYPOTHESIS BY BETTIE et al, estrogen acts on receptors other estrogen receptors to increase PONV.• FSH AND OR ESTROGEN RATIO PLAYS AN IMPORTANT ROLE.• ADDED STIMULUS OF ANAESTHESIA AND SURGERY.• ESTROGEN INCREASES THE NUMBER AND SENSITIVITY OF DOPAMINE RECEPTORS.
  • 18. AnaesthesiologyNO STATISTICAL SIGNIFICANCE IN BOTH THE GROUPS DEMOGRAPHIC PROFILE PRE OPERATIVE PARAMETERS POST OPERATIVE PARAMETERS• IDENTICAL PREMEDICATION AND ANAESTHETIC TECHNIQUE.• INCIDENCE OF PONV MENSTRUAL PHASE- 70% NON MENSTRUAL PHASE- 36.17%• THE INCIDENCE OF PONV WAS INCREASED IN MENSTRUAL GROUP AT 30, 90 MIN,6HRS AND 12 HRS BUT WAS HIGHLY SIGNIFICANT AT 12 HRS.
  • 19. Anaesthesiology CONCLUSIONTHE INCIDENCE AND SEVERITY OF PONV IS DEFINITELY INFLUENCED BY PHASE OF MENSTRUAL CYCLE.SURGICAL PROCEDURES ESPECIALLY DAY CARE SHOULD BE SCHEDULED DURING NON MENSTRUAL PHASE OF MENSTRUAL CYCLE.GOOD PRE-EMPTIVE ANTIEMETIC SHOULD BE GIVEN FOR SURGICAL PROCEDURES WHEN DONE DURING MENSTRUAL PHASE OF MENSTRUAL CYCLE.
  • 20. THANK YOU!