Alexander Mohan, Krishnan Balasubramanian, Yuvraj V
Department of Oral and Maxillofacial Surgery, DJ College of Dental Sciences and Research, Modinagar, UP, India.
J Oral Maxillofac Surg. 2009 Sep;67(9):1873-7. doi: 10.1016/j.joms.2009.04.094.
To determine the incidence of postoperative nausea and vomiting (PONV) after oral and maxillofacial surgical procedures and to evaluate the rationale behind prophylactic antiemetic medications.
A total of 167 patients, irrespective of age and gender, undergoing oral and maxillofacial surgical procedures under general anesthesia/dissociative anesthesia, were included. Risk factors associated with PONV such as gender, type of anesthetic agent used, nature of surgical procedure, surgical approach used, and duration of surgery and postoperative use of opioids were assessed. A "watch and wait" policy was adopted in all cases of recorded PONV with gastric lavage (GL) to be performed in patients with more than 2 episodes of PONV in the 6-hour postoperative period. The efficacy of such an intervention was also assessed. Antiemetic medications were given in only those cases which did not respond favorably to GL. A chi(2) test was performed using SPSS software (Chicago, IL) to determine statistical significance.
Of the 167 patients included, 19 patients experienced episodes of PONV. GL was performed in 3 patients, and all showed cessation of emesis after this intervention. No antiemetic medications were administered. A significant association was observed between PONV and female gender, duration of surgery, type of anesthetic agent used, and specific surgical procedures such as oncologic and temporomandibular joint surgeries. The role of surgical approach and the use of opioids in the postoperative period on the incidence of PONV were found to be insignificant.
Information regarding the incidence of PONV after oral and maxillofacial surgical procedures remains scanty. We conclude that there does not appear to be a rationale for the prophylactic administration of antiemetic drugs in such surgical procedures. A watch-and-wait policy and simple GL may provide significant relief. Antiemetic medications are to be considered only in case of non-responders and intractable PONV.
确定口腔颌面外科手术后恶心呕吐（PONV）的发生率，并评估预防性使用抗呕吐药物的理论依据。
纳入167例接受全身麻醉/分离麻醉下口腔颌面外科手术的患者，不限年龄和性别。评估与PONV相关的危险因素，如性别、所用麻醉剂类型、手术性质、手术方式、手术时间以及术后阿片类药物的使用情况。对于所有记录到的PONV病例均采用“观察等待”策略，术后6小时内发生2次以上PONV的患者进行洗胃（GL）。还评估了这种干预措施的效果。仅在对GL反应不佳的病例中给予抗呕吐药物。使用SPSS软件（伊利诺伊州芝加哥）进行卡方检验以确定统计学意义。
在纳入的167例患者中，19例出现PONV发作。3例患者进行了GL，所有患者在该干预后呕吐停止。未给予抗呕吐药物。观察到PONV与女性性别、手术时间、所用麻醉剂类型以及特定手术如肿瘤手术和颞下颌关节手术之间存在显著关联。发现手术方式和术后阿片类药物的使用对PONV发生率的影响不显著。
关于口腔颌面外科手术后PONV发生率的信息仍然很少。我们得出结论，在这类手术中预防性使用抗呕吐药物似乎没有理论依据。观察等待策略和简单的GL可能会提供显著缓解。仅在无反应者和顽固性PONV的情况下才考虑使用抗呕吐药物。
