Post Operative Nausea & Vomiting Dr.M.Kannan MD DA Professor And HOD Department of Anaesthesiology Tirunelveli Medical College.

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Presentation transcript:

Post Operative Nausea & Vomiting Dr.M.Kannan MD DA Professor And HOD Department of Anaesthesiology Tirunelveli Medical College

Post Operative Nausea & Vomiting

Regurgitation Passive process

Lower Oesophageal Sphincter Oesophageal Smooth muscle-intrinsic sphincter Crural fibers of the Diaphragm –extrinsic sphincter Oblique fibres of the Stomach

Gastric Emptying Gastric Emptying Time Adult- 5 to 6 hours Prolonged –Solid food,Fats Reduced- Liquid food Peadiatric –time-4h Infant-3h New Born-2h

Factors Associated with PONV Patient Factor Surgical Factor Anaesthetic Factor

Patient Factor -PONV Children Women Full Stomach Hiatus Hernia Gastric outlet Obstruction

Surgical Factor-PONV Type of Surgery -Gynaecological -ENT -Squint Surgery -Gastrointestinal Duration of Surgery Antibiotics

Anaesthetic Factor-PNOV Opiods Volatile Agents Postoperative Pain Hypotension – Spinal/Epidural Experience of Anaesthesiologist

Adverse Effect of PONV Patient Distress Aspiration of Stomach content Poor Surgical Outcome ? Intra cranial pressure Intraocular pressure Intra thoracic pressure Intra abdominal pressure Violent peristalsis Neurosursery Opthalmic surgery Head & Neck surgery Abdominal wound Oesophageal Surgery

Mendelsons Syndrome Aspiration Pneumonities Pathophysiological Canges -Atelectasis -Alveolar Oedema -Loss of Surfactant -Pulmonary Oedema

Pathophysiological Changes Intrapulmonry Shunting Hypoxia Hypocapnia Hypercapnia Pulmonary Hypertesion

Symptoms In drawing of intercostal space Wheezing Tachycardia Tachypnia

Prevention Head down Position &Neck turned to one side

Prevention Fasting Empty the Stomach Reduce the volume –Metclopramide Reduce the acidity-Sodium Citrate -H 2 blockers-Ranitidine Central acting -Ondesetron

Acts on Dopamine receptor – Stomach&CTZ Gastric emptying time Lower Oesophageal tone Dose 10mg IV or IM Effect 1-3min Metclopramide

Ranitidine H 2 Receptor antogonist Reduces Acidity Dose 50mg IV-1-2hours

Ondansetron 5 HT 3 Receptor Antagonist Stomach& CNS Dose 4 mg IV min

Prevention Suction of the Pharyngeal content

Prevention-Regurgitation Sellicks Maneuver

Intubation

Rapid-Sequence Induction Tendelenberg Position –Suction Apparatus Pre-Oxygenate 3-5Min Prior curarization Sellicks maneuver Thiopentone IV Succinylcholine IV Quick Intubation Extubation after full recovery

Treatment Pharyngeal Suction Intubation Broncheal lavage Positive Pressure Ventilation Bronchodilators

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