Post-discharge nausea and vomiting: an overlooked aspect of ambulatory anesthesia?

Abstract

uE to continuing advances in anesthetic and surgical techniques, modern ambula-tory surgical care has become remarkably safe, with very low overall mortality and morbidity. However, despite impressive pharmaco-logical developments, which allow precise tailoring of anesthetic concentrations to facilitate rapid and pre-dictable emergence and recovery, the problem of pos-toperative nausea and vomiting (PONV) remains an elusive and ongoing clinical challenge. up to the pres-ent time, anesthesiologists have focused the majority of their analgesic and antiemetic strategies on patient care, to the point of patient discharge from the hos-pital. This is reflected in the growing documentation of patients’ experiences with nausea and vomiting in the postanesthesia care unit. However, there has been relatively little research, to date, examining the prob-lem of post-discharge nausea and vomiting (PDNV) after patients have left the hospital. This is definitely an overlooked aspect of ambulatory anesthesia. Post-discharge symptoms are seldom serious or life threatening, but they can be unpleasant and distress-ing to patients. The complication of PDNV can also have a major impact on the overall functional status of the patient. Important consequences include: a) delay in the resumption of normal daily activities and readi-ness to work; b) potential economic impact for health care providers and patients themselves; and c) failure to comply with analgesic prescriptions, for fear that the analgesic medications may cause further nausea and vomiting, thus aggravating the existing distress.