Watcha M F, White P F
Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, USA.
Int Anesthesiol Clin. 1995 Winter;33(1):1-20.
In an editorial, Kapur [4] described perioperative nausea and vomiting as the big "little problem following ambulatory surgery." In contrast to the attitudes of some physicians, patients put a high value on freedom from nausea and emesis in the postoperative period and are willing to accept some pain and drowsiness as the cost of controlling PONV [85]. Until recently, there had been little change in the incidence of postoperative emesis since the introduction of halothane into clinical practice in 1956. However, the introduction of the IV anesthetic agent propofol and of the NSAID ketorolac, plus abandonment of the policy of insisting that patients drink before discharge, appear to have contributed to a recent decline in the incidence of emesis. With the availability of new antiserotonin drugs, the incidence of recurrent (intractable) emesis could be further decreased, particularly if combination therapy is used. Further research into the mechanisms of this common postoperative complication may help in improving the management of emetic sequelae in the future. Improvements in antiemetic therapy could have a major impact for surgical patients, particularly those undergoing ambulatory surgery. Just as pain is no longer considered an unavoidable part of the postoperative experience, so should nausea and vomiting be considered an avoidable side effect.
在一篇社论中，卡普尔[4]将围手术期恶心呕吐描述为门诊手术之后的重大“小问题”。与一些医生的态度不同，患者非常重视术后不出现恶心和呕吐，并且愿意接受一定程度的疼痛和嗜睡作为控制术后恶心呕吐（PONV）的代价[85]。直到最近，自1956年氟烷引入临床实践以来，术后呕吐的发生率几乎没有变化。然而，静脉麻醉剂丙泊酚和非甾体抗炎药酮咯酸的引入，再加上放弃了要求患者出院前饮水的政策，似乎导致了近期呕吐发生率的下降。随着新型抗5-羟色胺药物的出现，复发性（难治性）呕吐的发生率可能会进一步降低，尤其是如果采用联合治疗的话。对这种常见术后并发症的机制进行进一步研究，可能有助于未来改善呕吐后遗症的管理。止吐治疗的改进可能会对手术患者，尤其是接受门诊手术的患者产生重大影响。就像疼痛不再被认为是术后不可避免的一部分一样，恶心和呕吐也应该被视为可避免的副作用。
