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- Joseph R Brimsacombe, Christian Keller (29 February 2008)
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Pharyngeal stimuli and postoperative nausea and vomiting
- john c boncyk (20 February 2008)
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Joseph R Brimsacombe , Christian Keller
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The following is our reply: We thank Dr Boncyk for his comment; however, as the ProSeal LMA is a large object that is inserted into the pharynx, it is unlikely that a reduction in pharyngeal stimulation from gastric tube insertion via the drain tube is the cause of the lower frequency of nausea and vomiting with the ProSeal LMA. Perhaps Dr Boncyk should repeat our study but without use of a gastric tube. Indeed, we urge other researchers to repeat this study, as this finding, if proved correct, should have a substantial impact on clinical practice. Afterall, postoperative nausea and vomiting is one of our greatest enemies. J Brimacombe C Keller Conflict of Interest:None declared |
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john c boncyk, Anesthesiologist University of wisconsin medical school
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I read with interest your recent article revealing a lower incidence of nausea and vomiting in patients in which a Proseal laryngeal mask airway(LMA) was utilized as compared to an endotracheal tube.1 I am writing to suggest another possible cause for an increased incidence of nausea and vomiting in the patients in which an endotracheal tube was utilized. There is evidence that the mere placement of an orogastric tube and aspiration of gastric contents may increase the incidence of postoperative nausea and vomiting in patients with an endotracheal tube in place.2 Might it have been possible that passing the gastric tube through the Proseal LMA prevented the pharyngeal stimulus from it’s placement and thus lowered the incidence of postoperative nausea and vomiting? 1. Hohlrieder M, Brimacombe J, von Goedecke A, Keller C. Postoperative nausea, vomiting, airway morbidity, and analgesic requirements are lower for the Proseal laryngeal mask airway the tracheal tube in females undergoing breast and gynecological surgery. Br J Anaesth 2007;99:576-80. 2. Trepanier CA, Isabel L. Perioperative gastric aspiration increases postoperative nausea and vomiting in outpatients. Can J Anaesth 1993;40:325-8. Conflict of Interest:None declared |
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