Conference Lectures
PONV IN CHILDREN
(Dr.Rajani Sundar, GKNM Hospital, Coimbatore)
ABSTRACT
INTRODUCTION
There has been a remarkable improvement in safety of anaestheia by way of reduction in mortality and major morbidity. Now the focus of interest has shifted towards discomfort and dissatisfaction as crucial outcome for anaesthesia. PONV is one of the most common and unpleasant side effects of anaesthesia and surgery. It is called "big little problem" of anaesthesia. PONV not only distresses the child but also decreases parental satisfaction. It is one of the major cause for unanticipated adminission for day care surgery or delay in discharge.
Overall incidence if PONV in adults has decreased from 60% to 30%. but the incidence in children remains 40%. With this in mind we did an audit of PONV in G.Kuppuswamy Naidu Memorial Hospital from 17th March 2014 to 31st August 2014. All children coming to post operative ward after undergoing procedures under general anaesthesia were included in the study.
We had total of four hundred cases in our study. Out of 1st 200 cases 18 children had vomiting. Where as in the 2nd 200 cases the number was only 9. But if we separate the last hundred from this the incidence dropped to 2%. (2cases out of 100).
We could achieve this by identifying the high risk group and taking adequate preventive measures in this group. Risk factors taken into consideration were duration of surgery more than 30 minutes, age above 3 years, type of surgery or procedure and positive history of PONV. Preventive measures under taken were using prohylactic anti-emetics and avoiding emetogenic agents.
However we had limitations because of which our incidence is much lower than what is reported in literatures. The limitations were one the nature of surgical procedures done in our setup had low prediction risk for PONV. And the second limitation was that we did not assess the late onset PONV in this study. We are trying to get incidence of late onset PONV before the presentation.