The optimum management of nausea and vomiting during and after cesarean delivery.

Abstract

Intraoperative and postoperative nausea and vomiting (IONV and PONV) afflict up to 80% of parturients undergoing cesarean delivery with neuraxial anesthesia. Preventing nausea and emesis is a top priority for women undergoing cesarean delivery and is included in the quality of recovery measures and enhanced recovery after cesarean delivery protocols. The majority of known perioperative emetic triggers can be avoided or mitigated by optimizing anesthetic and surgical management. IONV may arise from spinal anesthesia-induced hypotension, intraoperative pain, and medications such as uterotonics and antibiotics. Furthermore, uterine exteriorization and peritoneal irrigation increase IONV risk. Conversely, preventing PONV mainly focuses on optimizing analgesia through an opioid-sparing, multimodal strategy. In addition, combination prophylactic antiemetic therapy should be instituted in this high-risk population to further reduce the risk of IONV and PONV.

• Authors: Hon Sen Tan, Ashraf S Habib
• Journal: Best practice & research. Clinical anaesthesiology (Best Pract Res Clin Anaesthesiol) Vol. 34 Issue 4 Pg. 735-747 (Dec 2020) ISSN: 1878-1608 [Electronic] Netherlands
• PMID: 33288123 (Publication Type: Journal Article, Review)
• Copyright: Copyright © 2020 Elsevier Ltd. All rights reserved.

Chemical References

• Antiemetics
• Dopamine Antagonists
• Serotonin 5-HT3 Receptor Antagonists

Topics

• Anesthesia, Obstetrical (adverse effects, methods)
• Antiemetics (administration & dosage)
• Cesarean Section (adverse effects, methods)
• Dopamine Antagonists (administration & dosage)
• Female
• Humans
• Injections, Spinal
• Intraoperative Complications (physiopathology, prevention & control)
• Postoperative Nausea and Vomiting (physiopathology, prevention & control)
• Pregnancy
• Serotonin 5-HT3 Receptor Antagonists (administration & dosage)