EVALUATION OF DIFFERENT DRUG COMBINATIONS IN PREVENTION OF POSTOPERATIVE NAUSEA AND VOMITING (Comparative Study)

Abstract

The role of postoperative nausea and vomiting (PONV) is often underestimated by anesthesiologists compared with other perioperative complications. It seems to be of minor importance. Rarely, it is lethal for the patient and almost never becomes chronic but it is an unpleasant experience for the patient. Physiology of nausea and vomiting key structures and pathways identified are: • The chemoreceptor trigger zone located in the area postrema receiving inputs from blood-born drugs or hormones and stimulated by them. • Vomiting center in the reticular formation, it coordinates the visceral and somatic components of the vomiting reflex. Risk factors of PONV 1) Patient-specific Female gender, non smoking, history of PONV, motion sickness, migrane, age, increases in children), obesity. 2) Anesthesia-related independent predictors: unexperienced anesthetists Anesthetic agents like opioids, nitrous oxide, some intravenous agents like ketamine and volatile anesthetic agents, regional anesthesia. 3) Surgery-related factors Type and duration of surgery. Management of postoperative nausea and vomiting. • Guideline 1: Identify Patients’ Risk for PONV • Guideline 2: Reduce Baseline Risk Factors for PONV • Guideline 3: Administer PONV Prophylaxis Using One to Two Interventions in Adults at Moderate Risk for PONV • Guideline 4: Administer Prophylactic Therapy with Combination (>2) Interventions/Multimodal Therapy in Patients at High Risk for PONV. • Guideline 5: Administer Prophylactic Antiemetic Therapy to Children at Increased Risk for POV; as in Adults, Use of Combination Therapy Is Most Effective • Guideline 6: Provide Antiemetic Treatment to Patients with PONV Who Did Not Receive Prophylaxis or in Whom Prophylaxis Failed.