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Postoperative nausea and vomiting

Authors
Jessica Feinleib, MD, PhD
Lori H Kwan, MD
Ammar Yamani, MD
Section Editors
Natalie F Holt, MD, MPH
Andrew Davidson, MD
Deputy Editor
Marianna Crowley, MD

INTRODUCTION

Nausea, vomiting, and retching frequently complicate recovery from anesthesia. Postoperative nausea and vomiting (PONV) is a patient-important outcome; patients often rate PONV as worse than postoperative pain [1]. PONV usually resolves or is treated without sequelae, but may require unanticipated hospital admission and delay recovery room discharge [2,3]. In addition, vomiting or retching can result in wound dehiscence, esophageal rupture, aspiration, dehydration, increased intracranial pressure, and pneumothorax.

The term PONV is typically used to describe nausea and/or vomiting or retching in the postanesthesia care unit (PACU) and in the immediate 24 postoperative hours. Postdischarge nausea and vomiting (PDNV) refers to symptoms that occur after discharge for outpatient procedures. Postoperative vomiting (POV) is usually measured and discussed in children, rather than PONV, because nausea may be difficult to assess in young children.

This topic will discuss the risk factors for PONV, preventive strategies, and treatment of PONV in adults and children. Pathophysiology of nausea and vomiting is discussed separately. (See "Approach to the adult with nausea and vomiting", section on 'Pathophysiology'.)

PATHOPHYSIOLOGY

Nausea and vomiting may be induced through a variety of central and peripheral mechanisms. (See "Approach to the adult with nausea and vomiting", section on 'Pathophysiology'.)

Five principle neurotransmitter receptors mediate nausea and vomiting: muscarinic M1, dopamine D2, histamine H1 5-hydroxytryptamine (HT)-3 serotonin, and neurokinin 1 (NK1) – substance P [4]. All of these receptors may be targets for prevention or treatment of PONV. The pathophysiologic pathways for PONV are shown in a figure (figure 1). (See 'Antiemetics' below.)

                                     

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Literature review current through: Nov 2016. | This topic last updated: Wed Nov 30 00:00:00 GMT+00:00 2016.
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