Post-operative nausea and vomiting

Postoperative nausea and vomiting
Classification and external resources
MeSH	D020250
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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.

Emetogenic drugs commonly used in anaesthesia include nitrous oxide, physostigmine and opioids. The intravenous anaesthetic propofol is currently the least emetogenic general anaesthetic. These medications are thought to stimulate the chemoreceptor trigger zone (CTZ). This area is on the floor of the fourth ventricle and is effectively outside of the blood-brain barrier. This makes it incredibly sensitive to toxin and pharmacological stimulation. There are multiple neurotransmitters such as histamine, dopamine, serotonin, acetylcholine, and the more recently discovered neurokinin-1 (substance P).

A 2008 study compared 121 Japanese patients who experienced PONV after being given the general anesthetic propofol to 790 people who were free of post-operative nausea after receiving it. Those with a G at both copies of rs1800497 were 1.6 times more likely to experience PONV within six hours of surgery compared to those with the AG or AA genotypes. But they were not significantly more likely to experience PONV more than six hours after surgery.

Postoperative nausea and vomiting results from patient factors, surgical factors, and anesthetic factors. It has been proven that there is a direct link between length of surgery and risk of postoperative nausea and vomiting (PONV). Due to the length of the procedure, abdominal and laparoscopic are at a higher risk for PONV. Procedures in ENT have an increased risk as well due to the involvement of the vestibulocochlear system. In addition to the length of the surgery the dose of the anesthetic also play a large role in the risk of PONV.

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.

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