Ismail Samina
Department of Anaesthesia, Aga Khan University Hospital, Karachi.
J Pak Med Assoc. 2008 Apr;58(4):203-5.
There is no agreed technique for minimizing PONV (Postoperative Nausea and Vomiting) although some techniques are associated with low rate. Best practice involves identifying high risk patients and surgeries and use of prophylactic antiemetic where appropriate. Laparoscopic gynaecological surgery has high incidence of PONV (54-92%). An audit on the practice of antiemetic use in diagnostic laparoscopic gynaecological surgery was done in the department of anaesthesia of Aga Khan University Hospital from 1st January to 30th June 2006. We included all the patients scheduled for this procedure lasting less than 90 minutes. Anaesthetist involved in the audit identified the patient falling into the predetermined risk factors. The following facts about antiemetic were noted; whether the patients received any antiemetics or not, if it was prophylactic or rescue, type, dose route and timing of antiemetic. Patients were rated for any signs of nausea and vomiting (retching) after extubation in the operating room by the anaesthetist and in the recovery room or surgical day care unit (SDC) by the nurse who was briefed about it and was cross checked by the anaesthetist involved in the audit. This was done for two hours postoperatively. Our results showed that only 75% of patients with risk factors received an antiemetic. The most commonly used antiemetic was Metoclopramide. Eight percent of the patients had vomiting and all of them had received a prophylactic antiemetic. They received the same rescue antiemetic. This audit recommended institutional guidelines for the management of PONV. These should be based on evidence obtained from the published peer-reviewed studies. These guidelines could be communicated to health care workers involved in postoperative management of patients to help them achieve an optimal management strategy for this uncomfortable postoperative complication.
目前尚无公认的可将术后恶心呕吐（PONV）降至最低的技术，尽管有些技术与之关联的发生率较低。最佳做法是识别高风险患者和手术，并在适当情况下使用预防性止吐药。妇科腹腔镜手术的PONV发生率很高（54 - 92%）。2006年1月1日至6月30日，阿迦汗大学医院麻醉科对诊断性妇科腹腔镜手术中使用止吐药的情况进行了一次审核。我们纳入了所有计划进行该手术且持续时间少于90分钟的患者。参与审核的麻醉师确定患者是否属于预先设定的风险因素。记录了以下关于止吐药的情况：患者是否接受了任何止吐药、是否为预防性或补救性用药、止吐药的类型、剂量、给药途径和时间。麻醉师在手术室对拔管后的患者进行恶心和呕吐（干呕）迹象的评分，在恢复室或外科日间护理单元（SDC）由了解情况的护士进行评分，并由参与审核的麻醉师进行交叉核对。术后两小时内均如此操作。我们的结果显示，只有75%有风险因素的患者接受了止吐药。最常用的止吐药是甲氧氯普胺。8%的患者出现呕吐，且他们都接受了预防性止吐药。他们接受了相同的补救性止吐药。此次审核建议制定关于PONV管理的机构指南。这些指南应基于从已发表的同行评审研究中获得的证据。这些指南可传达给参与患者术后管理的医护人员，以帮助他们针对这种令人不适的术后并发症制定最佳管理策略。
