Current Prevention and Treatment of Postoperative Nausea and Vomiting after Gynecological Laparoscopic Surgery

Abstract

Postoperative nausea and vomiting (PONV) are two of the commonest and most distressing complications of general anesthesia and surgery, with a remarkably high incidence after gynecological laparoscopic surgery. Numerous antiemetics have been studied for the prevention of PONV after gynecological laparoscopic surgery. Traditional antiemetics, including butyrophenones (e.g., droperidol) and benzamide (e.g., metoclopramide), are used for preventing PONV. The available non-traditional antiemetics for the prophylaxis against PONV are propofol, dexamethasone, and ephedrine. Serotonin receptor antagonists (ondansetron, granisetron, and dolasetron), compared with traditional antiemetics, are highly effective for PONV prophylaxis. None of the available antiemetics is entirely effective, perhaps because most of them act through the blockade on one type of receptor. There is a possibility that combined antiemetics with different sites of activity would be more effective than one drug alone for preventing PONV Combination antiemetic therapy with ondansetron and droperidol or dexamethasone is highly effective in the prevention of PONV. P6 acupoint injection is non-pharmacological technique and is as effective as droperidol for preventing PONV. Management of PONV after gynecological laparoscopic surgery depends on the prophylaxis. If the prophylactic therapy fails, treatment would be required. Ondansetron is effective in the treatment of established PONV. Knowledge regarding antiemetics is necessary to completely prevent and treat PONV in women undergoing gynecological laparoscopic surgery. Keywords: Butyrophenones, Droperidol, chemoreceptor trigger zone, Propofol, serotonin receptor antagonists