Abstract
Postoperative nausea and vomiting is a major cause of postoperative morbidity. It can lead to increased recovery time, delaying patient discharge and an increase in hospital costs. Past studies have shown that postoperative nausea and vomiting is more frequent in women than men, appears to elevate around the time of menarche and is reduced around the time of menopause. This retrospective review of a one-year experience oflaparoscopic tubal ligation at our institute examined the effect of menstrual cycle on postoperative nausea and vomiting. The anaesthetic and surgical techniques were consistent for all patients. Patient data included age, weight, last day of menstrual cycle, the length of anaesthetic, the dose of inhalational agent, the dose of narcotic, emesis on emergence and whether or not droperidol was used. Of the the 235 patients in the study, the incidence of nausea and vomiting was 28%. One hundred fifty-eight had had no preoperative antiemetic and 77 had received droperidol. These two groups were analyzed separately. The incidence in the group not receiving droperidol was 33.5% and in the droperidol group, 16.9% (P < 0.01). The incidence of nausea and vomiting was higher on the first eight menstrual days (51.6 vs21.6, P < 0.001), was highest on day five of the menstrual cycle and lowest on days 18, 19, and 20 where there was no nausea and vomiting. Droperidol reduced the incidence of postoperative nausea and vomiting but the variation inpostoperative nausea and vomiting during the cycle persisted. These data suggest that the scheduling of laparoscopy according to menstrual cycle may be more effective than droperidol alone in reducing postoperative nausea and vomiting. The relative risk of nausea and vomiting is four times greater during menses.
Résumé
Le vomissement et nausée postopératoires sont une cause majeure de morbidité postopératoire. lls peuvent occasionner une augmentation du temps de récupération, retarder le congé du patient et augmenter le coût de l’hospitalisation. Des études antérieures ont démontreque la nausée et vomissement sont plus fréquents chez les femmes plutôt que les hommes, l’incidence augmentant autour du temps de la ménarche et diminuant autour du temps de la ménaupose. Cette revue rétrospective d’une expérience d’un an de ligature tubaire par laparoscopie dans notre Institut examine les effets du cycle menstruel sur la nausée et vomissement postopératoires. Les techniques anesthésiques et chirurgicales étaient identiques pour toutes les patientes. Les données des patientes incluaient l’âge, le poids, le dernier jour de cycle menstruel, la duree de l’anesthésie, la dose des agents d’inhalation, la dose de narcotique, le vomissement à l’emergence et l’utilisation du dropéridol. Des 235 patientes de l’étude, l’incidence de nausée et vomissement était de 28%. Cent cinquante-huit patientes n’avaient reçu aucun antiémétique en période préopératoire et 77 patientes avaient reçu du dropéridol. Ces deux groupes furent analysés séparément. L’incidence dans le groupe n’ayant pas reçu de dropéridol était de 33.5% et celle du groupe dropéridol, 16.9% (P < 0.01). L’incidence de nausée et vomissement était plus élevée dans les huit premiers jours de la menstruation (51.6 versus 21.6, P < 0.001). Cette incidence atteignait un maximum au cinquième jour du cycle menstruel et un minimum au jour 18, 19, et 20 où on observa ni nausée ni vomissement. Le dropéridol a réduit l’incidence de nausée et vomissement postopératoires mais les variations postopératoires de la nausée et vomissement durant le cycle persistèrent. Ces données suggèrent que la cédule de la laparoscopie, dépendamment du cycle menstruel, pourrait être plus efficace que le droperidol seul, ofin de réduire l’incidence de nausée el vomissement postopératoires. Le risque relatif des nausées et vomissements est quatre fois plus grand durant les menstruations.
Article PDF
Similar content being viewed by others
References
Palazzo MGA, Strunin L. Review article: anaesthesia and emesis. I: Etiology. Can Anacsth Soc J 1984; 31: 178–87.
Palazzo MGA, Strunin L. Review article: anaesthesia and emesis II: Prevention and management. Can Anacsth Soc J 1984; 31: 407–15.
Rita L, Goodarzi M, Seleny F. Effect of low dose droperidol on postoperative vomiting in children. Can Anaesth Soc J 1981; 28: 259–62.
Forrest JB, Cahalan MK, Rehder K et al. Multiccnter study of general anesthesia. II. Results. Ancsthcsiology 1990; 72: 262–8.
Pataky AO, Kitz DS, Andrews RW, Lecky JH. Nausea and vomiting following ambulatory surgery: arc all procedures created equal? Anesth Analg 1988; 67: S163.
Kauppila A, Huhtanieme E, Ylikorkala O. Raised scrum HCG concentrations in hyperemesis gravidarum. BMJ 1979; 1: 1670–1.
Pommier RF, Woltering EA, Keenan EJ, Fletcher WS. The mechanism of hormone-sensitive breast cancer progression on antiestrogen therapy. Arch Surg 1987; 122: 1311–6.
Benz C, Gandara D, Miller B et al. Chcmocndocrinc therapy with prolonged estrogen priming in advanced breast cancer: endocrine pharmacokinetics and toxicity. Cancer Treat Rep 1987; 71: 283–9.
Stoelting RK. Drugs used in treatment of psychiatric disease.In: Stoelting RK (Ed.). Pharmacology and Physiology in Anesthetic Practice, Philadelphia: JB Lippincott, 1987; 347–64.
Pandit SK, Kothary SP, Pandit UA. Antiemetic efficacy of oral metoclopramide versus intravenous droperidol for outpatient laparoscopic procedures. Ancsthesiology 1987; 67: A425.
Williams JJ, Goldberg ME, Larijani GE et al. A blinded prospective comparison of different methods of reducing nausea and/or vomiting after out-patient surgery. Ancsthesiology 1988; 69: A907.
Young ML, Kitz DS, Andrews R, Lecky JH, Conahan TJ. Efficacy of antiemetic prophylaxis in patients receiving general anaesthesia for outpatient surgery. Anesthesiology 1988; 69: A449.
Hruska RE, Silbergeld EK. Increased dopamine receptor sensitivity after estrogen treatment using the rat rotation model. Science 1980; 208: 1466–7.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Beattie, W.S., Lindblad, T., Buckley, D.N. et al. The incidence of postoperative nausea and vomiting in women undergoing laparoscopy is influenced by the day of menstrual cycle. Can J Anaesth 38, 298–302 (1991). https://doi.org/10.1007/BF03007618
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF03007618