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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.
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.
Omission of nitrous oxide reduced the odds of postoperative nausea and vomiting by 37%, a reduction in risk of 28%.
MelbourneThis paper reviews reports on the incidence and importance of postoperative nausea and vomiting, and concludes that the main predisposing factors are the agent and technique used, premedicant drugs, the operation site, the age and sex of the patient and the duratioia of the operation. (The patient's) dread of the anzesthetic is not because of its danger . . . but because of the sickness which he anticipates as an inevitable consequence.-BLUMFELD, Lancet, I @ . THE IMPORTANCE OF POSTOPERATIVE VOMITING Although less important than formerly, nausea and vomiting remain unpleasant and sometimes serious sequela of anzsthesia. Riding (1963) lists the complications of postoperative nausea and vomiting as: I. Discomfort, possibly with soiling of clothing and bedding. 2. Aspiration of vomitus, and its harmful effects. 3. Strain on suture lines and promotion of haemorrhage, seriously jeopardizing good surgical results, particularly in eye and plastic operations. 4. Electrolyte disturbances, which, however, are rare. Bellville (1961) includes in this category trauma to the esophagus, interference with * Present address : Department of Anzsthesia, Royal Children's Hospital, Melbourne.proper nutrition and inability to tolerate oral medication. It is clear that remedial measures will be worth while provided that they do not cause complications of their own.
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