Neslihan ALKIŞ, Ali Abbas YILMAZ, Emine Aysu ŞALVIZ

Postoperatif bulantı-kusma: Risk faktörleri ve tedavi

Tüm dünyada yılda yaklaşık 80 ile 100 milyon hastaya genel anestezi altında cerrahi girişim uygulanmaktadır. Bunların % 20-30' unda çeşitli sebeplerle ilk 24 saat içerisinde bulantı ve kusma görülmektedir. Bulantı ve kusma; hastaların yaşam kalitesini ağrıdan daha fazla düşürür ve anksiyetelerini artırır. Gelişen dehidratasyon, elektrolit imbalansı, aspirasyon, pnömoni ve kanama gibi komplikasyonlar medikal tedaviye veya sekonder cerrahiye gereksinim doğurur. Gelişen her komplikasyon zaman, iş gücü ve maliyet açısından kayıp demektir. Günümüzde hastanede kalış süresinin uzaması, oluşan komplikasy onlar ve bunların tedavisi bulantı-kusmanın önlenmesini, yönetilmesini ve tedavisini önemli kılmaktadır. Postoperatif bulantı-kusmanın (POBK) primer tedavisi antimuskarinik, antihistaminik, dopamin D2 reseptör antagonistleri ve serotonin antagonistleri gibi farklı mekanizmalar ile etki eden ajanlar ile yapılabilmektedir. Serotonin antagonistleri, cerrahiye, kemoterapiye ve radyoterapiye bağlı oluşan bulantı ve kusmalarda etkinlik, güvenilirlik ve yan etki azlığı sebebi ile diğerlerinin önüne geçmektedir. Antimuskariniklerin antikolinerjik, antihistaminiklerin sedasyon, dopamin antagonistlerinin ise ekstrapiramidal yan etkileri mevcuttur. Kortikosteroidler, sedatifler, anksiyolitikler, substance-P (nörokinin-1) antagonistleri ve akupres gibi alternatif yöntemler ise primer tedaviye ek olarak kullanılabilecek ve cerrahi sonrası hastaları rahatlatabilecek diğer tedavi şekilleridir. Riskli hastalarda farklı reseptörler üzerinden etki gösteren ilaçların seçilmesi ve kombine tedavi uygulanması önerilmektedir. Tüm bu tedavi seçeneklerine karşılık maliyet hesabı da tedavi planının Bir parçası olmalıdır.

Anahtar Kelimeler:

Risk faktörleri, Terapötikler, Temas sonrası profilaksi, Ameliyat sonrası bulantı ve kusma

Postoperative nausea and vomiting: Risk factors and treatment

Worldwide annually, approximately 80-100 million operations are performed under general anesthesia. For various reasons, postoperative nausea and vomiting (PONV) are recorded in 20-30% of the procedures during the first 24 hours. This population includes both the patients without any risk factors and the patients with important risk factors that can be determined before the procedure. Nausea and vomiting are considered as an important symptom because they decrease the quality of life even more than postoperative pain and cause anxiety. Furthermore, they can cause complications such as dehydration, electrolite imbalance, aspiration, pneumonia; separation of the incision scar, haemorrhage which may lead to medical therapy or secondary surgery procedures. Such complications result in loss of time, money and manpower. Recently prolonged post-operative hospital stays, complications and unplanned admissions illustrate the importance of the prevention, management and therapy of nausea and vomiting. The primary therapy for PONV is antimuscarinics, antihistaminics, dopamin D2 receptor antagonists and serotonin antagonists. Serotonin antagonists are effective, safe and have fewer side effects and therefore are preferred for nausea related to surgery, chemotherapy or radiotherapy. Antimuscarinics have anticolinergic, antihistaminics have sedation and dopamin antagonists have extrapyramidol side effects. Alternative methods like corticosteroids, sedatives, anxiolytics, substance-P antagonists and acupressure can be combined with the therapy for patient relief. Medications that affect different receptors and combination therapies are recommended for patients with risk factors. Despite all these therapeutic choices, cost benefit is an important predictor in planning the therapy.

Keywords:

Risk Factors, Therapeutics, Post-Exposure Prophylaxis, Postoperative Nausea and Vomiting,

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