Postoperative Nausea and Vomiting in Plastic Surgery

Postoperative nausea and vomiting (PONV) is a common problem affecting nearly one third of all surgical patients. In addition to making the patient feel miserable, PONV is a major cause of prolonged recovery, unintended hospital admission, and poor patient satisfaction after surgery. Retching and vomiting can also lead to hematoma formation, wound and suture dehiscence, and aspiration. Thus, the prevention of PONV is an important goal in the overall outcome of surgery and, in particular, plastic surgery. The etiology of PONV is multifactorial, and several important risk factors have been identified. These factors include female gender, nonsmoking status, and a history of PONV or opioid-induced nausea and emesis. Volatile anesthetics and long operative duration also increase the risk of PONV. Reduction in the incidence of PONV requires careful assessment of patient-related risk factors as well as the appropriate use of prophylactic antiemetics. There are many antiemetic medications on the market today. Ondansetron, a serotonin 5-hydroxytryptamine antagonist, appears to be the current drug of choice for PONV prophylaxis. It has greatest efficacy and cost-effectiveness when used in patients at moderate to high risk. In addition, surgeons can consider using intravenous propofol or conscious sedation instead of general anesthesia where appropriate. KEYWORDS Postoperative - nausea - vomiting - emesis - PONV - antiemetic