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Post Operative Nausea & Vomiting

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

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Post Operative Nausea & Vomiting

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  1. Post Operative Nausea &Vomiting Dr.M.Kannan MD DA Professor And HOD Department of Anaesthesiology Tirunelveli Medical College

  2. Post Operative Nausea &Vomiting

  3. Regurgitation • Passive process

  4. Lower Oesophageal Sphincter • Oesophageal Smooth muscle-intrinsic sphincter • Crural fibers of the Diaphragm –extrinsic sphincter • Oblique fibres of the Stomach

  5. 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

  6. Factors Associated with PONV • Patient Factor • Surgical Factor • Anaesthetic Factor

  7. Patient Factor -PONV • Children • Women • Full Stomach • Hiatus Hernia • Gastric outlet Obstruction

  8. Surgical Factor-PONV • Type of Surgery -Gynaecological -ENT -Squint Surgery -Gastrointestinal • Duration of Surgery • Antibiotics

  9. Anaesthetic Factor-PNOV • Opiods • Volatile Agents • Postoperative Pain • Hypotension –Spinal/Epidural • Experience of Anaesthesiologist

  10. 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 Adverse Effect of PONV Real Danger

  11. Mendelsons Syndrome • Aspiration Pneumonities • Pathophysiological Canges -Atelectasis -Alveolar Oedema -Loss of Surfactant -Pulmonary Oedema

  12. Pathophysiological Changes • Intrapulmonry Shunting • Hypoxia • Hypocapnia • Hypercapnia • Pulmonary Hypertesion

  13. Symptoms • In drawing of intercostal space • Wheezing • Tachycardia • Tachypnia

  14. Prevention • Head down Position &Neck turned to one side

  15. Prevention • Fasting • Empty the Stomach • Reduce the volume –Metclopramide • Reduce the acidity-Sodium Citrate -H2blockers-Ranitidine Central acting -Ondesetron

  16. Metclopramide • Acts on Dopamine receptor –Stomach&CTZ • Gastric emptying time • Lower Oesophageal tone • Dose 10mg IV or IM • Effect 1-3min

  17. Ranitidine • H2 Receptor antogonist • ReducesAcidity • Dose 50mg IV-1-2hours

  18. Ondansetron • 5 HT3 Receptor Antagonist • Stomach& CNS • Dose 4 mg IV-10 -15 min

  19. Prevention • Suction of the Pharyngeal content

  20. Prevention-Regurgitation • Sellicks Maneuver

  21. Sellicks Maneuver

  22. Intubation

  23. 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

  24. Treatment • Pharyngeal Suction • Intubation • Broncheal lavage • Positive Pressure Ventilation • Bronchodilators

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