What is meant by postoperative


German: postoperative nausea and vomiting

1 definition

The abbreviation PONV stands for postoperative nausea and vomiting, the nausea and vomiting after surgery.

2 epidemiology

Every third patient suffers from nausea and vomiting after an operation.

3 etiopathogenesis

Stimulation of the vomiting center in the medulla oblongata leads to nausea and vomiting as well as paleness and cold sweat. Various chemoreceptors and the substances that bind to them (e.g. serotonin or histamine) are responsible for the development of nausea.

The risk factors for the development of nausea and vomiting after an operation include the female gender, as the symptoms manifest themselves much more often in women than in men. Age also seems to play a role, as postoperative nausea and vomiting are more commonly seen in younger people.

Absence of nicotine abuse also increases the risk of PONV, as smokers are less affected than non-smokers.

PONV continues to be seen more frequently in patients with motion sickness.

A condition after PONV also increases the risk of postoperative nausea and vomiting.

If the anesthetist uses inhalation anesthetics, the risk of postoperative nausea and vomiting is also increased. Postoperative administration of opioids also often leads to nausea and vomiting.

postoperative opioid administration
PONV risk factors
Female gender
History of PONV
Motion sickness in the Amanese
Non-smoking status
Operation time> 60 min

4 Clinic and Complications

The affected patients complain of nausea and vomiting, which significantly reduce their general well-being. Especially with inadequate protective reflexes, there is the possibility of aspiration of gastric juice, which can lead to Mendelson's syndrome and obstruction of the airways.

Recurrent vomiting still carries the risk of disturbances in the electrolyte balance.

5 therapy

Therapy consists of the administration of antiemetics such as dimenhydrinate, metoclopramide, ondansetron or dolasetron.

In Mendelson's syndrome, appropriate intensive care treatment with intubation and ventilation, administration of oxygen and administration of antibiotics, glucocorticoids and bronchospasmolytics should be carried out.

6 prophylaxis

For the prophylaxis of PONV, dexamethasone is administered at the beginning of the operation. Antiemetics such as Setrone, Dimenhydrinat or Droperidol can also have a prophylactic effect.

Since inhalation anesthetics increase the risk of PONV, total intravenous anesthesia (TIVA) should be used if the risk is high. Performing the operation under regional anesthesia also reduces the risk of postoperative vomiting and postoperative nausea.

When the above procedures are combined, the risk of PONV can be significantly reduced.

7 links

DocCheck News - PONV: Kotzeritis chirurgica