, Volume 31, Issue 4, pp 407-415

Anaesthesia and emesis II: Prevention and management

Conclusion

The causes of emesis associated with anaesthesia are varied and in any one patient are likely to be multifactorial. Our approach has been to emphasise those areas which can be controlled. However, general prophylactic measures, such as reduced gastric inflation, avoidance of opiate premedication and pharyngeal stimulation, might not be sufficient to prevent emesis. Although we do not recommend routine preoperative use of antiemetics because of their relatively high incidence of side effects, we do feel there is a place for prophylaxis under certain circumstances. Our drug of choice for prophylaxis would be droperidol 0.175 mg·kg-1 intravenously, given peroperatively, although a smaller dose can be effective. For operations involving the ear we would prefer promethazine given with the premedication or peroperatively. Once nausea and vomiting have begun, cyclizine 25–50 mg intramuscularly, or one of the piperazine phenothiazines (prochlor-perazine or perphenazine), would be appropriate. In the event of the first choice drug being ineffective, we would encourage the use of a second agent, preferably one with a different site of action. We feel that familiarity with a few drugs and more attention to the controllable factors mentioned should help reduce postoperative emesis.

An erratum to this article is available at http://dx.doi.org/10.1007/BF03008552.