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happening or done after a surgical operation; "postoperative complications"; "postoperative care"

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2012/10/07 06:52:37」(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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English Journal

Intra- and postoperative low-dose ketamine for adolescent idiopathic scoliosis surgery: a randomized controlled trial.

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Intravenous Delta-9-Tetrahydrocannabinol to Prevent Postoperative Nausea and Vomiting: A Randomized Controlled Trial.

Kleine-Brueggeney M1, Greif R, Brenneisen R, Urwyler N, Stueber F, Theiler LG.
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BACKGROUND: Evidence suggests that cannabinoids can prevent chemotherapy-induced nausea and vomiting. The use of tetrahydrocannabinol (THC) has also been suggested for the prevention of postoperative nausea and vomiting (PONV), but evidence is very limited and inconclusive. To evaluate the effective
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Transversus Abdominis Plane Block Versus Surgical Site Infiltration for Pain Management After Open Total Abdominal Hysterectomy.

Gasanova I1, Alexander J, Ogunnaike B, Hamid C, Rogers D, Minhajuddin A, Joshi GP.
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BACKGROUND: Surgical site infiltration and transversus abdominis plane (TAP) blocks are commonly used to improve pain relief after lower abdominal surgery. This randomized, observer-blinded study was designed to compare the analgesic efficacy of TAP blocks with surgical site infiltration in patients
PMID 26252171

Japanese Journal

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

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Neurologia medico-chirurgica, 2013
… All postoperative magnetic resonance (MR) images showed a relief of cervicomedullary compression and recreation of the cisterna magna. … Treatment of ventricular dilation is unnecessary before PFD as long as there is no persistent headache, vomiting, and papilledema. …
NAID 130003383213