1. Post Operative Nausea & Vomiting Dr.M.Kannan MD DA Professor And HOD Department of Anaesthesiology Tirunelveli Medical College

2. Post Operative Nausea & Vomiting

3. Regurgitation Passive process

4. Lower Oesophageal Sphincter Oesophageal Smooth muscle-intrinsic sphincter Crural fibers of the Diaphragm –extrinsic sphincter Oblique fibres of the Stomach

5. Gastric Emptying Gastric Emptying Time Adult- 5 to 6 hours Prolonged –Solid food,Fats Reduced- Liquid food Peadiatric –time-4h Infant-3h New Born-2h

6. Factors Associated with PONV Patient Factor Surgical Factor Anaesthetic Factor

7. Patient Factor -PONV Children Women Full Stomach Hiatus Hernia Gastric outlet Obstruction

8. Surgical Factor-PONV Type of Surgery -Gynaecological -ENT -Squint Surgery -Gastrointestinal Duration of Surgery Antibiotics

9. Anaesthetic Factor-PNOV Opiods Volatile Agents Postoperative Pain Hypotension – Spinal/Epidural Experience of Anaesthesiologist

10. Adverse Effect of PONV Patient Distress Aspiration of Stomach content Poor Surgical Outcome ? Intra cranial pressure Intraocular pressure Intra thoracic pressure Intra abdominal pressure Violent peristalsis Neurosursery Opthalmic surgery Head & Neck surgery Abdominal wound Oesophageal Surgery

11. Mendelsons Syndrome Aspiration Pneumonities Pathophysiological Canges -Atelectasis -Alveolar Oedema -Loss of Surfactant -Pulmonary Oedema

12. Pathophysiological Changes Intrapulmonry Shunting Hypoxia Hypocapnia Hypercapnia Pulmonary Hypertesion

13. Symptoms In drawing of intercostal space Wheezing Tachycardia Tachypnia

14. Prevention Head down Position &Neck turned to one side

15. Prevention Fasting Empty the Stomach Reduce the volume –Metclopramide Reduce the acidity-Sodium Citrate -H 2 blockers-Ranitidine Central acting -Ondesetron

16. Acts on Dopamine receptor – Stomach&CTZ Gastric emptying time Lower Oesophageal tone Dose 10mg IV or IM Effect 1-3min Metclopramide

17. Ranitidine H 2 Receptor antogonist Reduces Acidity Dose 50mg IV-1-2hours

18. Ondansetron 5 HT 3 Receptor Antagonist Stomach& CNS Dose 4 mg IV-10 -15 min

19. Prevention Suction of the Pharyngeal content

20. Prevention-Regurgitation Sellicks Maneuver

22. Intubation

23. Rapid-Sequence Induction Tendelenberg Position –Suction Apparatus Pre-Oxygenate 3-5Min Prior curarization Sellicks maneuver Thiopentone IV Succinylcholine IV Quick Intubation Extubation after full recovery

24. Treatment Pharyngeal Suction Intubation Broncheal lavage Positive Pressure Ventilation Bronchodilators