Anaesthesia and emesis. I: Etiology

Abstract

One of the most distressing side effects following anaesthesia is the occurrence of nausea, often followed by retching and vomiting.In a review of the subject in 1963 Riding felt that postoperative "sickness" was less frequent and severe than in the preceding twenty years. ~ However, examination of more recent literature suggests that the incidence of postoperative "sickness" has probably not changed although its severity may have. It is, however, difficult to compare these studies as there was little attempt by many authors to define nausea, retching, or vomiting, indeed postoperative "sickness" is often used interchangeably with these terms. The studies variably included one or all of these symptoms; population samples, anaesthetic conditions, and periods of follow up also differed (Table I).This article will review our current understanding of the physiology of emesis (nausea, retching and vomiting) and evaluates the part played by anaesthesia in its aetiology. In a second review we will examine the methods and agents available to anaesthetists for prevention or treatment of emetic symptoms. Clearly there are several factors not directly related to anaesthesia that influence the incidence of emetic episodes (nausea, retching, or vomiting). These factors include metabolic, vestibular and psychogenic disturbances, gastro-intestinal and intraeranial disorders and administration of agents with emetic potential such as ergometrine.In these cases there is often little the anesthetist can do to influence the primary pathology and so brief mention will be made of these.

The antiemetic effectiveness of droperidol during morphine patient‐controlled analgesia

“…General anaesthesia without specific antiemetic therapy is associated with a 2WO% incidence of postoperative vomiting [6,7] and postoperative nausea occurs in up to 55% of cases [4]. The type of postoperative analgesic regimen employed would be expected to have an influence on the incidence and severity of this complication.…”

Metoclopramide in the prevention of postoperative nausea and vomiting: a quantitative systematic review of randomized, placebo-controlled studies

“…The mean incidence domized, controlled studies had several goals: first, to define of postoperative nausea and vomiting (PONV) is approxi-the antiemetic efficacy of metoclopramide compared with mately 30%, although this varies widely depending on placebo or no treatment in the prevention of PONV; second, different clinical settings, patient characteristics and other to establish dose-responsiveness; third, to compare antipoorly defined factors. [1][2][3] nausea with anti-vomiting efficacy; and fourth, to investigate Metoclopramide, a dopamine and serotonin receptor an-the potential for toxic effects of metoclopramide in the tagonist, was discovered almost 40 yr ago. 4 The first clinical surgical setting.…”

Distribution of ran-domised controlled trials of drugs for post-operative nausea and vomiting

“…Three reviews (none systematic) of the subject [1][2][3] have been published in the major English-language anesthesiology journals. The last of these discusses the desirability of basing treatment on randomised controlled trials (RCTs), and the difficulty of interpreting RCTs done in the area.…”