post operative nausea & vomiting
DESCRIPTION
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 - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: Post Operative Nausea & Vomiting](https://reader035.vdocuments.us/reader035/viewer/2022070410/5681465e550346895db37e6b/html5/thumbnails/1.jpg)
Post Operative Nausea &Vomiting
Dr.M.Kannan MD DAProfessor And HODDepartment of
AnaesthesiologyTirunelveli Medical College
![Page 2: Post Operative Nausea & Vomiting](https://reader035.vdocuments.us/reader035/viewer/2022070410/5681465e550346895db37e6b/html5/thumbnails/2.jpg)
Post Operative Nausea &Vomiting
![Page 3: Post Operative Nausea & Vomiting](https://reader035.vdocuments.us/reader035/viewer/2022070410/5681465e550346895db37e6b/html5/thumbnails/3.jpg)
Regurgitation
• Passive process
![Page 4: Post Operative Nausea & Vomiting](https://reader035.vdocuments.us/reader035/viewer/2022070410/5681465e550346895db37e6b/html5/thumbnails/4.jpg)
Lower Oesophageal Sphincter
• Oesophageal Smooth muscle-intrinsic sphincter
• Crural fibers of the Diaphragm –extrinsic sphincter
• Oblique fibres of the Stomach
![Page 5: Post Operative Nausea & Vomiting](https://reader035.vdocuments.us/reader035/viewer/2022070410/5681465e550346895db37e6b/html5/thumbnails/5.jpg)
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
![Page 6: Post Operative Nausea & Vomiting](https://reader035.vdocuments.us/reader035/viewer/2022070410/5681465e550346895db37e6b/html5/thumbnails/6.jpg)
Factors Associated with PONV
• Patient Factor
• Surgical Factor
• Anaesthetic Factor
![Page 7: Post Operative Nausea & Vomiting](https://reader035.vdocuments.us/reader035/viewer/2022070410/5681465e550346895db37e6b/html5/thumbnails/7.jpg)
Patient Factor -PONV
• Children• Women• Full Stomach• Hiatus Hernia• Gastric outlet
Obstruction
![Page 8: Post Operative Nausea & Vomiting](https://reader035.vdocuments.us/reader035/viewer/2022070410/5681465e550346895db37e6b/html5/thumbnails/8.jpg)
Surgical Factor-PONV
• Type of Surgery
-Gynaecological
-ENT
-Squint Surgery
-Gastrointestinal• Duration of Surgery• Antibiotics
![Page 9: Post Operative Nausea & Vomiting](https://reader035.vdocuments.us/reader035/viewer/2022070410/5681465e550346895db37e6b/html5/thumbnails/9.jpg)
Anaesthetic Factor-PNOV
• Opiods• Volatile Agents• Postoperative Pain• Hypotension –
Spinal/Epidural• Experience of
Anaesthesiologist
![Page 10: Post Operative Nausea & Vomiting](https://reader035.vdocuments.us/reader035/viewer/2022070410/5681465e550346895db37e6b/html5/thumbnails/10.jpg)
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
![Page 11: Post Operative Nausea & Vomiting](https://reader035.vdocuments.us/reader035/viewer/2022070410/5681465e550346895db37e6b/html5/thumbnails/11.jpg)
Mendelsons Syndrome
• Aspiration Pneumonities
• Pathophysiological Canges
-Atelectasis
-Alveolar Oedema
-Loss of Surfactant
-Pulmonary Oedema
![Page 12: Post Operative Nausea & Vomiting](https://reader035.vdocuments.us/reader035/viewer/2022070410/5681465e550346895db37e6b/html5/thumbnails/12.jpg)
Pathophysiological Changes
• Intrapulmonry Shunting
• Hypoxia• Hypocapnia• Hypercapnia• Pulmonary
Hypertesion
![Page 13: Post Operative Nausea & Vomiting](https://reader035.vdocuments.us/reader035/viewer/2022070410/5681465e550346895db37e6b/html5/thumbnails/13.jpg)
Symptoms
• In drawing of intercostal space
• Wheezing
• Tachycardia
• Tachypnia
![Page 14: Post Operative Nausea & Vomiting](https://reader035.vdocuments.us/reader035/viewer/2022070410/5681465e550346895db37e6b/html5/thumbnails/14.jpg)
Prevention
• Head down Position &Neck turned to one side
![Page 15: Post Operative Nausea & Vomiting](https://reader035.vdocuments.us/reader035/viewer/2022070410/5681465e550346895db37e6b/html5/thumbnails/15.jpg)
Prevention
• Fasting
• Empty the Stomach
• Reduce the volume –Metclopramide
• Reduce the acidity-Sodium Citrate
-H2blockers-Ranitidine
Central acting -Ondesetron
![Page 16: Post Operative Nausea & Vomiting](https://reader035.vdocuments.us/reader035/viewer/2022070410/5681465e550346895db37e6b/html5/thumbnails/16.jpg)
• Acts on Dopamine receptor –Stomach&CTZ
• Gastric emptying time
• Lower Oesophageal tone
• Dose 10mg IV or IM
• Effect 1-3min
Metclopramide
![Page 17: Post Operative Nausea & Vomiting](https://reader035.vdocuments.us/reader035/viewer/2022070410/5681465e550346895db37e6b/html5/thumbnails/17.jpg)
Ranitidine
• H2 Receptor antogonist
• Reduces Acidity
• Dose 50mg IV-1-2hours
![Page 18: Post Operative Nausea & Vomiting](https://reader035.vdocuments.us/reader035/viewer/2022070410/5681465e550346895db37e6b/html5/thumbnails/18.jpg)
Ondansetron
• 5 HT3 Receptor Antagonist
• Stomach& CNS
• Dose 4 mg IV-10 -15 min
![Page 19: Post Operative Nausea & Vomiting](https://reader035.vdocuments.us/reader035/viewer/2022070410/5681465e550346895db37e6b/html5/thumbnails/19.jpg)
Prevention
• Suction of the Pharyngeal content
![Page 20: Post Operative Nausea & Vomiting](https://reader035.vdocuments.us/reader035/viewer/2022070410/5681465e550346895db37e6b/html5/thumbnails/20.jpg)
Prevention-Regurgitation
• Sellicks Maneuver
![Page 21: Post Operative Nausea & Vomiting](https://reader035.vdocuments.us/reader035/viewer/2022070410/5681465e550346895db37e6b/html5/thumbnails/21.jpg)
Sellicks Maneuver
![Page 22: Post Operative Nausea & Vomiting](https://reader035.vdocuments.us/reader035/viewer/2022070410/5681465e550346895db37e6b/html5/thumbnails/22.jpg)
Intubation
![Page 23: Post Operative Nausea & Vomiting](https://reader035.vdocuments.us/reader035/viewer/2022070410/5681465e550346895db37e6b/html5/thumbnails/23.jpg)
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
![Page 24: Post Operative Nausea & Vomiting](https://reader035.vdocuments.us/reader035/viewer/2022070410/5681465e550346895db37e6b/html5/thumbnails/24.jpg)
Treatment
• Pharyngeal Suction• Intubation• Broncheal lavage• Positive Pressure
Ventilation • Bronchodilators