Why people feel sick after anesthesia (and what helps)

Anesthesia side effects · 2 min read

Postoperative nausea and vomiting (PONV) is one of the most common complaints after general anesthesia. A prospective study of 143 plastic surgery patients found that a multi-drug prevention regimen reduced PONV from a published 22% to 3%.

A randomized trial of 150 ambulatory plastic surgery patients (all with general anesthesia) found that adding aprepitant to ondansetron reduced vomiting: 9.3% vs 29.7% of patients vomited, mostly after discharge (the incidence of nausea itself did not differ significantly). The authors note that incidence can be as high as 80% in some settings, with most outpatient symptoms occurring after discharge.

Awake angle: many awake approaches avoid the volatile anesthetics and breathing tube altogether, and prevention strategies are layered in when sedation is used.

If you have had PONV before, tell us. It changes the plan.

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References

1. Steely RL, Collins DR, Cohen BE, Bass K. Postoperative nausea and vomiting in the plastic surgery patient. Aesthetic Plast Surg. 2004;29-32. PMID 15116276
2. Vallejo MC, Phelps AL, Ibinson JW, et al. Aprepitant plus ondansetron compared with ondansetron alone in reducing postoperative nausea and vomiting in ambulatory patients undergoing plastic surgery. Plast Reconstr Surg. 2012;519-526. PMID 21987042