Postoperative Nausea and Vomiting
Laparoscopy is frequently associated with minor postoperative
sequelae (see Chapter 68
)
that can persist more than 48 hours and that can significantly delay discharge of
outpatients.[221]
In addition to postoperative
pain of various types, the most frequent complaints are headache, sore throat (in
case of endotracheal intubation), and nausea and vomiting. Postoperative nausea
and vomiting (PONV) is one of the main complaints after laparoscopy (40% to 75% of
patients),[222]
[223]
[224]
and the most important factor determining
the
length of stay after ambulatory anesthesia.[225]
Whereas intraoperative opioids increase the incidence of PONV,[226]
[227]
propofol anesthesia can markedly reduce the
high incidence of these side effects.[225]
The
effect of N2
O on the incidence of nausea is still controversial.[228]
[229]
[230]
[231]
[232]
[233]
Drainage
of gastric contents also reduces PONV.[234]
Intraoperative
administration of droperidol and the use of ondansetron appear to be helpful in the
prevention and treatment of these side effects.[235]
[236]
[237]
[238]
[239]
Perioperative oxygen supplement halves the
incidence of PONV in one study[240]
but was ineffective
in another study.[241]
Transdermal scopolamine
reduces nausea and vomiting after outpatient laparoscopy.[222]
Analgesic techniques that allow reductions of opioid consumption can contribute
to decreasing these symptoms.[242]
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