Post on 13-Feb-2016
description
Post Operative Nausea &Vomiting
Dr.M.Kannan MD DAProfessor And HODDepartment of
AnaesthesiologyTirunelveli 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
-H2blockers-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
• H2 Receptor antogonist
• Reduces Acidity
• Dose 50mg IV-1-2hours
Ondansetron
• 5 HT3 Receptor Antagonist• Stomach& CNS• Dose 4 mg IV-10 -15 min
Prevention
• Suction of the Pharyngeal content
Prevention-Regurgitation
• Sellicks Maneuver
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