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Post Operative Nausea &

Vomiting

Oleh:
Andy

Pembimbing:
dr. Eddy Harijanto, SpAn-KIC
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 • Neurosursery
• Intraocular pressure • Opthalmic surgery
• Intra thoracic pressure • Head & Neck surgery
• Intra abdominal pressure • Abdominal wound
• Violent peristalsis • 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
Metclopramide
• Acts on Dopamine receptor –
Stomach&CTZ
• Gastric emptying time
• Lower Oesophageal tone
• Dose 10mg IV or IM
• Effect 1-3min
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

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