PONV, or postoperative nausea and vomiting, is the most common problem patients experience after surgery requiring anesthesia. It occurs in approximately 30% of patients and is caused by stimulation of various neurotransmitter receptors in the brain and gut. Risk factors include a history of PONV, non-smoking status, age under 50, and certain surgical procedures like cholecystectomy or gynecological surgery. Prophylaxis involves reducing baseline risk factors, administering antiemetics that target the 5-HT3, glucocorticoid, anticholinergic, and neurokinin 1 receptors, and meeting specific discharge criteria once patients have sufficiently recovered.
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1. PONV
PONV: postoperative nausea and vomiting
Most common problem in PACU
In 30% of patient; mostly in general anesthesia
Neurotransmitter/receptor involved:
1) muscarinic receptor 1 (M1)
2) dopamine receptor 2 (D2)
3) histamine 1 (H1)
4) 5-HT3R
5) neurokinin 1 (NK1) receptor - substance P
8. Prophylaxis
1. Reduce baseline risk:
Adequate hydration (20 ml/kg)
Multimodal post-OP pain control:
Regional anesthesia, acetaminophen, NSAID, etc.
Modification of anesthesia:
Regional anesthesia or TIVA with propofol
9.
10. Prophylaxis
1. Reduce baseline risk:
Adequate hydration (20ml/kg)
Multimodal post-OP pain control:
Regional anesthesia, acetaminophen, NSAID, etc.
Modification of anesthesia:
Regional anesthesia or TIVA with propofol
11. Prophylaxis
2. Antiemetics (↓ 25% of PONV)
1) 5-HT3 receptor antagonist
Ondansetron: 4 mg, onset: immediately; use at the end of surgery
Granisetron: 1 mg
Dolasetron: 12.5 mg, onset: 15 min
Palonosetron: 0.075 mg; use at the end of surgery
2) Glucocorticoid - dexamethasone: 4-10 mg
Antiemetics and analgesic
Use after induction