Postop. nausea and vomiting?

Nurses General Nursing

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I know that with post operative nausea and vomiting, there are several factors that are ingolfed including, the type of surgery, length of surgery, intra operative opioid administration, volatile anesthetics, etc.

But as far as IV induction agents/ sedatives, are propofol and Midazolam the only ones that don't have emetic effects and/ or have antiemetic effects?

I know they are rarely used anymore, but what about barbiturate anesthetics/ induction agents like Methohexital, or sodium thiopental? For those that use to use them (or maybe still do) did you find they caused a lot of Post op N/V? If so, do you think it was the drugs themselves that contributed to the vomiting? Or do you think it was just that they had a lack of antiemetic effects like propofol so they didn't block all the break through N/V from other surgical factors (ie opioids) like propofol would?

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Specializes in Psych, Addictions, SOL (Student of Life).

This feels like a student question: Don't get me wrong we are generally happy to help with homework as long as we see you have made an attempt to figure it out on your own. I would suggest that you do some research on the topic and formulate your own answers which you can then run by us for comments/suggestions. You school should have on-line Library resources to nursing research but if not you might try Google Scholar.

Hppy

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This isn't for homework, just curiousity and I've done tons of searching.

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Specializes in Psych, Addictions, SOL (Student of Life).
This isn't for homework, just curiousity and I've done tons of searching.

I found several articles pertaining to the subject on Google Scholar using search string Nausea and vomiting comparative studies.

Google Scholar

Good luck with your research!

Hppy

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I know that with post operative nausea and vomiting, there are several factors that are ingolfed including, the type of surgery, length of surgery, intra operative opioid administration, volatile anesthetics, etc.

All those factors can have an effect on PONV incidence. Also, don't forget the patient-related risk factors (female gender, non-smoking, history of motion sickness etc.).

I know they are rarely used anymore, but what about barbiturate anesthetics/ induction agents like Methohexital, or sodium thiopental? For those that use to use them (or maybe still do) did you find they caused a lot of Post op N/V? If so, do you think it was the drugs themselves that contributed to the vomiting? Or do you think it was just that they had a lack of antiemetic effects like propofol so they didn't block all the break through N/V from other surgical factors (ie opioids) like propofol would?

(my bold)

I'm not really sure what you're asking here. PONV is complex and the physiology behind it isn't perfectly understood. When you ask if posters "found" that such-and-such med combo caused "a lot" of PONV, it sounds like your asking for the personal opinions, as opposed to scientific data, of various posters who have anesthesia experience? Is it anecdotes you're looking for or research? My anecdotal guesstimates of the etiology of the vomiting in specific cases isn't really worth a lot.

One of my anecdotal experiences is for example that my patients more frequently have PONV when I reverse neuromuscular blockade with neostigmin compared to sugammadex reversal. Also, the patients who display a high level of anxiety pre-op seem to experience PONV more often. And my senior citizen patients hardly ever get PONV (especially not the ones who have a regular afternoon glass of sherry ;)). Have I controlled for confounding factors? Nope.. Should you take my word for any of this? No :)

I'm not being a deliberate **** here. I'm trying to encourage you to look at the available research. I agree with happygr8ful, your questions do sound a bit like homework. Perhaps they aren't, but I'm curious about your interest in this topic? Are you considering a career in anesthesia or are you already working in a place where some of these "anesthesia medications" are frequently administered?

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All those factors can have an effect on PONV incidence. Also, don't forget the patient-related risk factors (female gender, non-smoking, history of motion sickness etc.).

(my bold)

I'm not really sure what you're asking here. PONV is complex and the physiology behind it isn't perfectly understood. When you ask if posters "found" that such-and-such med combo caused "a lot" of PONV, it sounds like your asking for the personal opinions, as opposed to scientific data, of various posters who have anesthesia experience? Is it anecdotes you're looking for or research? My anecdotal guesstimates of the etiology of the vomiting in specific cases isn't really worth a lot.

One of my anecdotal experiences is for example that my patients more frequently have PONV when I reverse neuromuscular blockade with neostigmin compared to sugammadex reversal. Also, the patients who display a high level of anxiety pre-op seem to experience PONV more often. And my senior citizen patients hardly ever get PONV (especially not the ones who have a regular afternoon glass of sherry ;)). Have I controlled for confounding factors? Nope.. Should you take my word for any of this? No :)

I'm not being a deliberate **** here. I'm trying to encourage you to look at the available research. I agree with happygr8ful, your questions do sound a bit like homework. Perhaps they aren't, but I'm curious about your interest in this topic? Are you considering a career in anesthesia or are you already working in a place where some of these "anesthesia medications" are frequently administered?

Well yes, I am looking for person experiences as what you read online can often be conflicting.

So what I was asking was (for those of you that use or previously used) barbiturate such as methohexital or sodium thiopental, if you found them to be correlated with a high incidence of post op nausea or vomiting? If yes, do you think it's the barbiturate anesthetic itself? Or do you think it's other factors such as opioid administration that would normally be suppressed with the antiemetic effeces of propofol?

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Anyone else have any other experiences?

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