WordNet

happening or done after a surgical operation; "postoperative complications"; "postoperative care"
the state that precedes vomiting (同)sickness
disgust so strong it makes you feel sick

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外科手術後の
吐き気 / 強いけんお(loathing)

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2012/11/19 15:54:04」(JST)

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Postoperative nausea and vomiting (PONV) is an unpleasant complication affecting about a third of the 10% of the population undergoing general anaesthesia each year. This equates to about two million people in the United Kingdom annually.

Impact

On average the incidence of nausea or vomiting after general anesthesia ranges between 25 and 30% [Cohen 1994]. Nausea and vomiting can be extremely distressing for patients and is therefore one of their major concerns [Macario 1999]. Vomiting has been associated with major complications such as pulmonary aspiration of gastric content and might endanger surgical outcomes after certain procedures, for example after maxillofacial surgery with wired jaws. Nausea and vomiting can delay discharge and about 1% of patients scheduled for day surgery require unanticipated overnight admission because of uncontrolled postoperative nausea and vomiting.

Management

Because no currently available antiemetic is especially effective by itself, and successful control is often elusive, experts recommend a multimodal approach. Anaesthetic strategies to prevent vomiting include using regional anaesthesia wherever possible and avoiding emetogenic drugs. Pharmacological treatment and prevention of postoperative nausea and vomiting is limited by both cost and the adverse effects of drugs. Patients with risk factors probably warrant prophylaxis, whereas a "wait and see" strategy is appropriate for those without risk factors.

In conjunction with antiemetic medications, at least one study has found that application to the Pericardium Meridian 6 accupressure point produced a positive effect in relieving postoperative nausea and vomiting.^[1] Another study found no statistically significant difference.^[2]

Continuous Wound Infiltration may reduce PONV and the need for post-operative pain management drugs.

Pharmacology

The introduction of the 5HT₃ receptor antagonist, ondansetron, in the early 1990s was a significant breakthrough. Despite the many studies, however, the evidence base to support rational antiemetic treatment remains patchy. Recent research has led to better understanding of some older drugs and has demonstrated that combinations of drugs are often useful. While the efficacy of droperidol is now clear, metoclopramide, a popular antiemetic for decades, was found to have limited efficacy at the lower traditional dosage. Some older drugs, such as haloperidol and hyoscine remain inadequately studied.

Emetogenic drugs commonly used in anaesthesia include nitrous oxide, physostigmine and opioids. The intravenous anaesthetic propofol is currently the least emetogenic general anaesthetic.

Risk factors

Postoperative nausea and vomiting results from anaesthesic, surgical, and patients factors. Gynaecological, urological, strabismus correction and middle ear surgery all have a higher risk of postoperative nausea and vomiting.

Patients that are female or who have a history of postoperative nausea and vomiting are at greater risk. Smokers have a decreased risk, but this would never be recommended by any physician. Older patients suffer less PONV.

Obesity, age less than 16 years, past history of motion sickness and high levels of pre-operative anxiety are also risk factors for PONV.

References

^ "Accupressure Treatment For The Prevention Of Postoperative Nausea And Vomiting". http://www.anesthesia-analgesia.org/cgi/reprint/84/4/821.pdf.
^ "Effect of acupressure on postoperative nausea and vomiting in laparoscopic cholecystectomy.". http://www.biomedexperts.com/Abstract.bme/12705488.

Cohen MM, Duncan PG, DeBoer DP, Tweed WA. The postoperative interview: assessing risk factors for nausea and vomiting. Anesth Analg 1994;78:7-16.

Macario A, Weininger M, Carney S, Kim A. Which clinical anesthesia outcomes are important to avoid? The perspective of patients. Anesth Analg 1999:89(9):652-8

Tramèr MR. Treatment of postoperative nausea and vomiting. BMJ 2003;327:762-3. Fulltext. PMID 14525850.

Gan TJ: Risk factors for postoperative nausea and vomiting. Anesth Analg. 2006 Jun;102(6):1884-98. Review. PMID 16717343

UpToDate Contents

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1. 悪心および嘔吐を伴う成人に対するアプローチ approach to the adult with nausea and vomiting
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English Journal

Dexamethasone produces dose-dependent inhibition of sugammadex reversal in in vitro innervated primary human muscle cells.

Rezonja K1, Sostaric M, Vidmar G, Mars T.Author information 1From the *Department of Anesthesiology and Intensive Therapy, University Medical Centre Ljubljana; and †Institute for Biostatistics and Medical Informatics and ‡Institute of Pathophysiology, University of Ljubljana, Ljubljana, Slovenia.AbstractBACKGROUND: Corticosteroids are frequently used during anesthesia to provide substitution therapy in patients with adrenal insufficiency, as a first-line treatment of several life-threatening conditions, to prevent postoperative nausea and vomiting, and as a component of multimodal analgesia. For these last 2 indications, dexamethasone is most frequently used. Due to the structural resemblance between aminosteroid muscle relaxants and dexamethasone, concerns have been raised about possible corticosteroid inhibition in the reversal of neuromuscular block by sugammadex. We thus investigated the influence of dexamethasone on sugammadex reversal of rocuronium-induced neuromuscular block, which could be relevant in certain clinical situations.
Anesthesia and analgesia.Anesth Analg.2014 Apr;118(4):755-63. doi: 10.1213/ANE.0000000000000108.
BACKGROUND: Corticosteroids are frequently used during anesthesia to provide substitution therapy in patients with adrenal insufficiency, as a first-line treatment of several life-threatening conditions, to prevent postoperative nausea and vomiting, and as a component of multimodal analgesia. For th
PMID 24651229

Comparison of propofol and volatile agents for maintenance of anesthesia during elective craniotomy procedures: systematic review and meta-analysis.

Chui J1, Mariappan R, Mehta J, Manninen P, Venkatraghavan L.Author information 1Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.AbstractBACKGROUND: Both propofol and volatile anesthetics are commonly used for maintenance of anesthesia in patients undergoing neurosurgical procedures. The effects of these two classes of drugs on cerebral hemodynamics have been compared in many clinical trials The objectives of this review were to evaluate the cerebral hemodynamic effects, operative conditions, recovery profiles, postoperative complications, and neurological outcomes of propofol-based vs volatile-based anesthesia for craniotomy.
Canadian journal of anaesthesia = Journal canadien d'anesthesie.Can J Anaesth.2014 Apr;61(4):347-356. Epub 2014 Jan 31.
BACKGROUND: Both propofol and volatile anesthetics are commonly used for maintenance of anesthesia in patients undergoing neurosurgical procedures. The effects of these two classes of drugs on cerebral hemodynamics have been compared in many clinical trials The objectives of this review were to eval
PMID 24482247

Extrapyramidal symptoms following administration of oral perphenazine 4 or 8 mg: An 11-year retrospective analysis.

Henao JP1, Peperzak KA, Lichvar AB, Orebaugh SL, Skledar SJ, Pippi MA, Williams BA.Author information 1From the Department of Anesthesiology, University of Pittsburgh Medical Center (JPH, KAP, SLO), School of Pharmacy (ABL, SJS), Department of Anesthesiology, University of Pittsburgh (MAP), and Department of Anesthesiology, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA (BAW) *John P. Henao and Katherin A. Peperzak are co-lead authors for the article.AbstractBACKGROUND: Perphenazine is a treatment option in postoperative nausea and vomiting (PONV) prophylaxis. Chronic administration and high dose are known to cause extrapyramidal system (EPS) dysfunction at a frequency of 8%, but the incidence of acute EPS after a single 4 or 8 mg dose is unknown.
European journal of anaesthesiology.Eur J Anaesthesiol.2014 Apr;31(4):231-5. doi: 10.1097/EJA.0000000000000048.
BACKGROUND: Perphenazine is a treatment option in postoperative nausea and vomiting (PONV) prophylaxis. Chronic administration and high dose are known to cause extrapyramidal system (EPS) dysfunction at a frequency of 8%, but the incidence of acute EPS after a single 4 or 8 mg dose is unknown.OBJE
PMID 24503705

Japanese Journal

成人型ウイルムス腫瘍の1例

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秋田医学 40(1), 29-33, 2013-06-28
… Therefore, he was referred to our pediatric division to undergo postoperative treatments. … During the treatment period, he suffered from both nausea and neurotoxicity due to the chemotherapy. …
NAID 120005325208

Incidence of and Risk Factors for Postoperative Nausea and Vomiting at a Japanese Cancer Center: First Large-Scale Study in Japan

森野良蔵
東京女子医科大学雑誌 83(2), 141-142, 2013-04-25
NAID 120005302561

口腔扁平上皮癌術後ハイリスク群における3週毎シスプラチンを用いた化学放射線療法の検討

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日本口腔腫瘍学会誌 25(1), 1-6, 2013
口腔扁平上皮癌術後ハイリスク症例に対する，シスプラチンを用いた術後化学放射線治療の検討を行った。17例中13例が完遂し，完遂率は76.5%であった。CTCAE Version 4.0 にてGrade 3以上の副作用は白血球減少5例，貧血4例，低K血症 3例，口腔粘膜炎1例，クレアチニン上昇1例，悪心2例，食欲不振3例であった。経験の蓄積とともに完遂率は向上するものと考えられ，標準治療として十分に遂 …
NAID 130003378720