What are PONV and PDNV? Why do they occur?

Nausea is the unpleasant feeling that you get when you're about to vomit. Vomiting is the act of forcefully expelling the stomach's contents out through the mouth.

Postoperative nausea and vomiting, also called PONV, is nausea and vomiting that occurs after surgery. When PONV happens after a person goes home from hospital, it is called post-discharge nausea and vomiting (PDNV).

Depending on individual factors and the type of surgery, PONV can happen in about 30% of people after surgery. It may last up to 5 days. In about 1% of people who have surgery, PONV is so severe that the person must be readmitted to the hospital.

PDNV can occur after the person leaves the hospital. At home, people are no longer under close medical supervision, so symptoms of nausea and vomiting can go untreated or under-treated. This may lead to discomfort and inability to do normal activities, and may delay recovery.

PONV and PDNV are caused by a variety of factors such as gender, age, prior history, and type of surgery. The surgery itself can activate processes in the body that lead to nausea and vomiting. Certain medications used during and after surgery can also cause nausea and vomiting. These include anaesthetics (used to relieve pain and relax you into surgery) and narcotics (relieve more intense and persistent pain).

All material copyright MediResource Inc. 1996 – 2020. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/healthfeature/gethealthfeature/Surgery-Related-Nausea-and-Vomiting

Am I at risk?

The risk of PONV and PDNV varies widely depending on the person and the surgery.

Risk factors can be divided into four categories: personal characteristics, type of surgery, medication use, and post-operative factors.

Certain groups of people are at a higher risk of PONV and PDNV. These include women, non-smokers, people who are anxious, people who are overweight, and people who have had PONV, motion sickness, or morning sickness in the past.

The type of surgery also plays a role in the risk of PONV and PDNV. Surgeries on certain areas of the body have a higher risk of PONV and PDNV, including the eye, ear, nose, throat (such as having the tonsils out), teeth, breast, uterus and related organs (such as hysterectomy, sterilization, or D&C), and abdomen (such as stomach, intestine, and gall bladder). Certain types of surgeries, such as plastic surgery, orthopedic surgery (such as shoulder or joint replacement), and laparoscopic surgery, can also have a higher risk of PONV and PDNV. (Laparoscopic surgery is an exam in which the surgeon makes a small cut in the abdomen area to pass a small telescope-like instrument with a light on one end through for viewing and examining the organs in the abdominal cavity.) The risk is also increased with longer surgeries.

Medication used during and after surgery can increase the risk of PONV and PDNV. Anaesthetics given by inhalation have a higher risk than those that are injected. The use of narcotic pain relievers such as morphine or codeine during and after surgery can also increase the risk of PONV and PDNV.

Post-operative factors (things that happen after the operation) also affect the risk of PONV and PDNV. Dehydration, anxiety, and poor pain control can all increase the risk of PONV and PDNV.

All material copyright MediResource Inc. 1996 – 2020. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/healthfeature/gethealthfeature/Surgery-Related-Nausea-and-Vomiting

Can PONV and PDNV cause any serious problems?

PONV and PDNV can cause serious problems. Because fluids are lost when a person vomits, people with PONV and PDNV can become dehydrated. Dehydration is more likely to occur in children, the elderly, or people with severe or long-lasting vomiting. Severe dehydration can lead to irregular heart rhythms, seizures, brain damage, or death.

Vomiting involves forceful contractions of the stomach. This can put pressure on the surgical wound and stitches, and may lead to tissue damage, reopening of the wound, or bleeding.

Another potentially serious problem associated with PONV and PDNV is called "aspiration." This is where vomit is accidentally breathed in to the lungs. Aspiration can lead to a lung infection known as "aspiration pneumonia."

All material copyright MediResource Inc. 1996 – 2020. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/healthfeature/gethealthfeature/Surgery-Related-Nausea-and-Vomiting

How can PONV and PDNV be prevented or treated?

A variety of medications can be used to prevent PONV and PDNV. These medications may also be used to treat PONV and PDNV if they occur. Because PDNV occurs after hospital discharge, medications for PDNV can be convenient for use if needed at home.

Medications that are used to prevent and treat nausea are called "antiemetics." In people at high risk of PONV and PDNV, a combination of two different antiemetics is usually used to prevent PONV and PDNV. In people at lower risk, a single medication is often used.

There are many different types of antiemetics. These medications work by interrupting the natural processes involved in nausea and vomiting.

Selective serotonin (5HT3) antagonists, such as ondansetron, granisetron, and dolasetron are available in both injectable and tablet forms. The main side effects are headache, constipation, and flushing.

Dexamethasone, a corticosteroid, may be used in combination with antiemetics such as 5HT3 antagonists for added benefits in people with a high risk of PONV and PDNV. Dexamethasone is available in injection and tablet forms. The main short-term side effects include stomach discomfort, mood changes, metallic taste, increased blood sugar, and headache. If used for a long period of time, corticosteroids can cause more severe side effects, including osteoporosis, decreased immune function, stomach ulcers, and possibly cataracts.

Antihistamines, such as dimenhydrinate, can be given by mouth, rectally, or by injection. Dimenhydrinate taken by mouth is available over the counter (without a prescription) and may be used at home. Its main side effects include drowsiness, dry mouth, and constipation. Since it can cause drowsiness, it can affect a person's ability to drive and perform other activities requiring alertness.

Anticholinergics, such as scopolamine, are another type of antiemetic. Scopolamine is available as an injection or as a disc. The disc may be used at home. It is applied to the skin behind the ear. Its main side effects include drowsiness, dry mouth, difficulty urinating, and skin rash.

Dopamine antagonists, such as metoclopramide, are a type of antiemetic that helps food move through the stomach more quickly. Metoclopramide is given by mouth or as an injection. Its main side effects are drowsiness, dizziness, and headache. Less commonly, it can also cause a more severe type of side effect known as extrapyramidal symptoms (EPS). These include restlessness, grimacing, eye rolling, trouble swallowing, slowed movement, tremors, and rigidity.

Prevention of PONV is not effective for everyone. If you have experienced PONV or think you are more prone to it than most people, consult with your doctor about what is appropriate for you.

All material copyright MediResource Inc. 1996 – 2020. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/healthfeature/gethealthfeature/Surgery-Related-Nausea-and-Vomiting