Resident Readiness General Surgery - Plot & Excerpts
Tarbox, MD andMamta Swaroop, MD, FACSA healthy 30-year-old female undergoes an uneventful, elective ventral hernia repair under general anesthesia. She goes to the surgical floor, where she receives a hydromorphone PCA for pain control and is kept NPO until return of bowel function. She does well until postoperative day 2, when she develops nausea and vomiting. Her nurse calls you asking what to do. You evaluate the patient. When you arrive at her bedside, you find her sitting up in bed leaning over an emesis bin. She tells you she has been vomiting intermittently for the past 2 hours. Her incision looks benign and her abdomen is not distended. She has infrequent bowel sounds.1. What is the best medication to give her to help with her symptoms?2. Is this patient’s nausea and vomiting likely due to the lingering effects of anesthesia?3. Does this patient need an NG tube?POSTOPERATIVE NAUSEA AND VOMITINGAnswers1. There are 3 types of afferent nerve inputs that ultimately result in vomiting—input from the vestibular complex, input from the viscera, and input from the chemoreceptor trigger zone in the base of the fourth ventricle.
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