Nausea after surgery is a fearful and tense situation to be in. After a successful operation, it is equally essential that the patient recovers well. As the body recovers and the effect of anaesthesia wear off, specific symptoms and complications start to develop.
Why are you experiencing this? Did you know why the patient feels nauseated after surgery? Can post-surgery nausea and vomiting get severe and put the patient in more trouble?
How to prevent it? Here, get to know all about this and learn how to handle such a situation.
Nausea After Surgery
At times, medications are not able to cure an ailment. Then, the invasive procedure of surgery is the solution. Or the only possible answer is surgery. However, an air of fear and uncertainty always surrounds it.
The surgery in itself classified into three stages:
- Pre-surgery: Where the patient is made ready for the operation. Typically, for a day or two before the procedure, the patient is under medical care and supervision. His diet and medicines are suited to enable smooth and uncomplicated surgery.
- The actual surgery: The exact procedure gets executed here. Also, out of the three stages, the highest risk resides in this stage.
- Post-surgery recovery.: once the operation is over, the patient needs some time and attention to recover and come back to his health.
In short, all three stages are critical. And all have their significance in achieving the medical objective. Generally, post-surgery recovery exhibits lots of symptoms. They are either related to the operative procedure or the body’s reaction to the surgery and treatment.
Typically, as the anzca.edu says, nausea and vomiting are widespread symptoms seen in after surgery.
Why Is Nausea Common After Surgery?
Surgery involves making an incision on the body. But it can be excruciating and traumatic for the patient. Hence, the patient is rendered unconscious by using anaesthesia. It can be general anaesthesia, where the patient is unconscious and completely unaware of what is going around.
According to the pharmaceutical-journal, general anaesthesia induced to the patient with a combination of drugs and anaesthetics (gases). Since it is a very specialised procedure, a specialist known as an anesthesiologist conducts it. Accompanied by a certified registered nurse anesthesiologist (CRNA). Beforehand, a patient is thoroughly analysed and checked up. It is to determine how the patient should be made unconscious. But it is not only about making the patient unconscious. The strategy designed and deployed to ensure, less complication during and after the surgery.
Anaesthesia reduces the resistance of the body to almost zero. Therefore, till the time the patient is under anaesthesia, a very sterile environment needs to be maintained.
Throughout the operation, the anesthesiologist monitors the patient very carefully. Also, all the vital signs of the patient are under continuous watch. Once the surgery completes, the anesthesiologist gets the patient back to consciousness very gradually.
Depending on the operation and the condition of the patient, he decides the dosage, the timing and a large number of other relevant parameters. Along with, he has to meet the surgeon’s requirement and keep the patient’s safety in mind
However, in the case of minor surgery or procedure, doctors use local anaesthesia.
The most common or rather almost certain after effect of surgery is nausea and vomiting. Medically it is termed as PONV (post-operative nausea and vomiting).
Predominantly nausea and vomiting are after-effects of anaesthesia. The after-effects, also known as the risk of anaesthesia. The anaesthetic gases are more prone to cause PONV than intravenous medications. Besides, apart from the anaesthetic drugs, there are other factors which aid or trigger PONV.
For a long time, the body is without the intake of food and water. Typically for most of the surgeries, it is advised to not eat anything, At least 6 hours before the surgery. Also, add to it the time for the pre-surgery process, surgery and post-surgery (recovery) time. Effectively, the body is without water and food for a very long time. Therefore, dehydration and empty stomach also contribute to the nauseating sensation.
Also, medications before and after an operation, on an empty stomach raise the acidity.
Moreover, acidity adds to nausea. The opioid-based pain killers, in particular, have a terrible effect on the empty stomach.
Below mentioned surgeries have a higher likelihood of PONV:
- Operations in the abdominal areas and genitals.
- Gynaecological surgeries
- Ear, nose and throat operations.
- Squint eye operations
- Operation of very long durations.
Comparatively, females and children are more prone to develop PONV. Non-smokers are at a higher risk of suffering from nausea and vomiting.
Also, patients with motion sickness very quickly tend to develop PONV.
Tips To Prevent Nausea And Vomiting After Surgery
Post-operative nausea and vomiting are not fatal. But it is extremely discomforting and annoying. It adds to the post-operative pain.
PONV delays the recovery process. Hence, the stay in the hospital extended. Additionally, hospitalisation expenses escalate.
Vomiting sensation and the vomiting itself strains the operation wound. The pressure on the raw sutures increases substantially. As a consequence, the wound may bleed and lead to unwarranted complications. The general disposition of the patient is severely affected.
Prevention of Nausea and vomiting is more advisable and viable than treating it. The anesthesiologist can give medicines to the patient during the anaesthesia process itself. Before that, analysing the risk factors of the patient is necessary. It suppresses the symptoms of PONV, once the patient comes out of the operation theatre.
Using the Apfel scale, the anesthesiologist can determine the possibility of PONV occurring in the patient. Information on gender, age, past PONV history, motion sickness and smoking, give the doctor a fair indication of what is to come.
How To Reduce The Impact Of Nausea After Surgery
Based on our research in American Society of Anaesthesiologists, there are other measures that can help reduce the incidence of the impact of nausea and vomiting are:
- Keep the patient hydrated. With improved medical science and technology, the doctor may permit the drinking of plain water. Even a few hours before surgery. A hydrated body can withstand the vomiting urge better than a dry one.
- Chew on ginger candies. Ginger is an excellent antidote for vomiting and nausea. Hence, it immediately suppresses the urge to throw up.
- Go back to regular food very gradually.
- Some people find the smell of food and eatable hard to bear. Hence, keep the room well ventilated, so that food smell does not bother the patient.
- Some patients find cold temperatures soothing to rest and recuperate. If that is so, keep the room temperature low.
- Avoid strong scents and fragrances.
- Take a slow and deep breath
- Any inconvenience or discomfort of nausea or vomiting calls for reporting to the nursing staff.
If postoperative nausea and vomiting occur, some medications can reduce or suppress the symptoms. However, the doctor should prescribe medication. One should not go for self-medication.
- Zofran (ondansetron): it works to prevent as well as treat vomiting and nausea.
- Phenergan (promethazine): This is a trendy medication for nausea and vomiting. However, the patient feels sedated because of this drug and may sleep off.
- Reglan (metoclopramide): Because of anaesthesia, the intestines winds down it functions and becomes dull and sluggish. It triggers nausea and vomiting. On the other hand, Reglan revives the intestines and revs it up to its original form. So, any nausea because of the intestine is taken care of.
- Compazine: This drug has multi-purpose uses. One of them is to control nausea and vomiting.
- Scopolamine: Though primarily it is used to treat motion sickness, but works well on nausea and vomiting also.
A nasogastric tube is inserted right till the stomach. It suctions off all contents of the stomach, in case the vomiting is excessive.
When Does The PONV Become A Risk?
PONV is very common in almost all post-operative cases. However, with proper care and medical treatment, it goes off in a couple of days.
But, if nausea and vomiting persist and worsens, it is a matter of concern. Repeated vomiting lays high stress on the fresh wound. To begin with, it may start bleeding. And that may intervene in the healing and recuperation.
There is always this danger of dehydration and electrolytic imbalance. Then the body throws out a lot of liquid during the vomiting.
Wound dehiscence is the worst thing to happen. In simple terms it means, the suture, stitches or the staples start coming apart. It happens because of extreme pressure on the wound. Besides, if the vomiting persists and medical attention not given, the wound may open up completely. It is quite dangerous and classified as a medical emergency.
Therefore, remedial action required immediately before evisceration of a wound begins. When the internal organs start coming out of the wound, it is known as evisceration. It is an awful and complicated situation.
In case of very violent vomiting, the oesophagus may get punctured. And this condition is known as oesophagal perforation.
Also, during frequent and intense vomits, the food particles or liquid may get into the windpipe. Pulmonary aspiration of gastric contents can take a fatal turn.
Other Side Effects After Surgery
Apart from PONV, there are other side effects associated with surgery. These side effects may last from few hours to few days. Usually, it goes off without any complications.
But then during the recovery period, it would be very prudent to oversee these symptoms. And any aggravation of the symptoms should be medically dealt with very swiftly and efficiently.
Some of the common side effects to mention are:
The patient is under the influence of anaesthesia and entirely unconscious. All the sensation and motor reactions to any provocation, however painful, is reduced to zero. In such a state, there is always a danger of obstructed breathing.
A breathing tube inserts through the mouth and throat that facilitates easy breathing. It is to prevent any danger. It avoids the risk of throat muscles collapsing because of over relaxing.
However, post-operation, the removal of this tube irritates the air passage in the throat, and it feels very sore and thorny. Generally, this feeling does not last beyond a day.
In the unconscious state, the patient grinds the jaws together very forcefully and violently. Consequently, it may result in some tooth damage. Though not a very common side effect, it does happen.
In such cases, intubation (inserting tube through the mouth for breathing) is also a problem. Anti-lockjaw devices are available. These devices hardly help.
Along with anaesthesia, to relieve pain, it is customary to use opioid-based pain relievers. After surgery, as the patient gradually gets conscious, there is itching on the body because of the narcotic pain killer.
Muscle relaxants, along with the anaesthesia, have a very profound relaxing effect on the muscles. As the impact of the medicines wears off, the muscles feel sore, and they develop aches.
Chills And Shivering
As the patient regains consciousness, he feels cold and chill. The patient shivers because of the cold. This reaction present in about 50% of the cases. But it wears off in some time when the patient covers in warmer and blanket.
Anaesthesia and the associated medicines work very actively on the brain. Slowly, the patient starts coming out of the effect of anaesthesia. He may find it difficult to remember and understand as to what is going around him. Since his mind is perplexed, he does not remember much.
Possibly one may not recognise friends and relatives. This feeling of delirium keeps recurring for a few days. At times, in between these delirium attacks, he can remember and identify people.
Having family members and friends around helps early recovery.
However, in some case, this post-operative delirium syndrome can extend for months together. And that is a dangerous complication.
There is a very severe reaction to anaesthesia by some individuals. In between the operation itself, the patient develops a very high fever. It is because of the response to anaesthesia. It is a hazardous reaction of the body. Generally, this runs in the family, if someone in the patient’s family has this allergic reaction. Immediately, it calls for the doctor’s notice without fail.
Most of the side effects are just temporary lasting for just a couple of days.
Post-surgery is as crucial as the surgery. Here the body recovers from the invasive procedure. It overcomes the effect of all drugs and medicines administered before and during the operation. Therefore, very close monitoring of the post-operative stage ensures that recovery is on the right path.