From the Guidelines
Postoperative nausea and vomiting (PONV) is the most common complication of general anesthesia in cesarean sections. This is due to various factors including physiological changes of pregnancy, manipulation of abdominal contents, and the use of opioids for postoperative pain control 1. According to a Cochrane review study, the incidence of PONV can be reduced with the use of antiemetic agents such as 5-HT3 antagonists (eg, ondansetron, granisetron), dopamine antagonists (eg, metoclopramide, droperidol), and sedatives (eg, midazolam, propofol) 1.
Failed intubation, on the other hand, is a more serious but relatively rare complication, with an incidence of about 1:300 to 1:500 in obstetric patients. The use of a multimodal approach to prevent PONV, including prophylactic antiemetics, is recommended 1. This approach can help reduce the incidence of PONV and improve patient outcomes.
Some key points to consider in preventing PONV include:
- The use of combination regimens, such as 5-HT3 antagonists combined with either droperidol or dexamethasone, which have been shown to be more effective than 5-HT3 alone 1
- The administration of antiemetic agents, such as tropisetron 2 mg and metoclopramide 20 mg, which have been shown to be highly effective in preventing nausea and vomiting 1
- The identification of risk factors for PONV, including female gender, non-smoking status, history of motion sickness or previous PONV, and postoperative opioid use.
Overall, PONV is a significant complication of general anesthesia in cesarean sections, and a multimodal approach to prevention is recommended 1.
From the Research
Complications of General Anesthesia in Cesarean Section
- The most common complication of general anesthesia in a cesarean section is postoperative nausea and vomiting (PONV) 2, 3, 4.
- PONV is a common and distressing side effect of anesthesia and surgery, causing significant distress to patients and potentially leading to severe complications 2.
- Failed intubation is a serious complication, but it is not as common as PONV in cesarean sections under general anesthesia.
- Studies have shown that PONV can be prevented or managed with various therapeutic modalities, including antiemetic prophylaxis, acupressure, and optimization of anesthesia techniques 5, 3, 4, 6.
Comparison of Complications
- PONV is more common than failed intubation in cesarean sections under general anesthesia, with studies reporting a higher incidence of PONV 2, 3.
- Failed intubation is a serious complication that can have significant consequences, but it is relatively rare compared to PONV.
- The incidence of PONV can be reduced with proper prophylaxis and management, making it a key area of focus for anesthesiologists and healthcare providers 2, 4.
Management of PONV
- Antiemetic prophylaxis is an effective way to prevent PONV, with studies showing a significant reduction in the incidence of PONV with the use of antiemetic agents 2, 6.
- Acupressure has also been shown to be effective in preventing PONV, with studies reporting a significant reduction in the incidence of nausea and vomiting 3.
- Optimization of anesthesia techniques, including the use of regional anesthesia and minimization of surgical stimuli, can also help to reduce the incidence of PONV 5, 4.