British Journal of Anaesthesia, Vol 83, Issue 1 104-117, Copyright © 1999 by The Board of Management and Trustees of the British Journal of Anaesthesia
J. B. Rose and M. F. Watcha
The past decade has witnessed the introduction of several significant
innovations to combat POV, particularly the introduction of serotonin
antagonists and the use of combinations of drugs for analgesia and control
of POV. Based on current knowledge, the anaesthetic plan for a patient with
a previous history of severe PONV and undergoing a procedure known to be
associated with a high incidence of this problem should include
premedication with a benzodiazepine and/or clonidine and the preferential
use of regional anaesthetic techniques. If general anaesthesia is
essential, anaesthetists should consider the use of propofol for both
induction and maintenance of anaesthesia, together with avoidance of
nitrous oxide, opioids and neuromuscular antagonists. Pain control is
extremely important, and a peripheral regional block should be used if
possible. A combination of prophylactic antiemetics such as dexamethasone,
a 5-HT3 antagonist and an antiemetic of a different class (e.g.
perphenazine or dimenhydrinate) should be administered. Non-pharmacological
measures such as acupressure and suggestion should also be considered,
together with nursing measures to avoid sudden movement from one position
to another during the postoperative period. A quiet environment, adequate
i.v. fluids and not forcing the patient to drink before discharge all
contribute to decreased emesis. It is possible that the advent of a new
class of antiemetic agents, the NKI antagonists, may have major effects on
the incidence of this complication. Drugs in this group differ from other
currently available drugs in having the ability to effectively block the
emetic response to many stimuli in experimental animals. Postoperative
vomiting remains a significant problem, resulting in patient suffering and
prolonged recovery from anaesthesia. Our aim should be to eliminate this
complication in all children who require surgery. It should not be
considered merely as the 'big, little problem'.
THE PAEDIATRIC PATIENT
Postoperative nausea and vomiting in paediatric patients
Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia and The University of Pennsylvania School of Medicine, 34th Street and Civic Center Blvd, Philadelphia, PA 19104, USA
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