European Journal of Cardiovascular Medicine

Postoperative nausea and vomiting (PONV) is a common and unpleasant problem frequently reported by the patients following general anesthesia. The etiology of PONV is multifactorial, involving patient characteristics, anesthetic techniques, and surgical factors. Multiple neural centers like the vomiting center and the chemoreceptor trigger zone are involved in the pathophysiology of vomiting. In laparoscopic surgeries, incidences of PONV are higher due to factors like pneumoperitoneum and peritoneal stretching. PONV is not a life-threatening condition, but it can cause significant patient discomfort, delay recovery and prolong hospital stay. In some patients it may also lead to complications like electrolyte imbalance, wound dehiscence, and aspiration pneumonitis. Identifying high-risk patients for PONV is essential for implementing targeted prophylactic interventions. This study was undertaken to evaluate the incidence of PONV and investigate the perioperative risk factors contributing to its occurrence in patients undergoing elective laparoscopic surgeries.

A prospective observational study was conducted in the Department of Anesthesiology, Assam Medical College and Hospital, Assam, India, over a period of 6 months from July to December 2024. A total of 150 patients, aged 18 to 60 years both male and female of ASA grade I and II, scheduled for elective laparoscopic surgeries like cholecystectomy, appendicectomy and laparoscopic gynecological procedures under general anesthesia were included.

Exclusion criteria included pregnancy, history of motion sickness or pre-existing nausea, use of antiemetic within 24hrs before surgery and emergency procedures.

Premedication with Ondansetron 0.1mg/kg, Glycopyrrolate 4mcg/kg, Induction agent Propofol 2mg/kg IV, muscle relaxant Rocuronium 1mg/kg, and inhalational agent Sevoflurane to maintain anesthesia was used for all the patients. Injection Sugammadex 2mg/kg IV was used to reverse the neuromuscular blockade.

Demographic data, intraoperative opioid use, duration of surgery and the occurrence of PONV within 24hrs postoperatively was recorded.

Statistical analysis was performed using SPSS. Descriptive statistics, Chi-square test, and logistic regression were used. A p-value <0.005 was considered statistically significant.

Table 1: Demographic characteristics

Table 2: Intraoperative variables

Table 3: Incidence and characteristics of PONV

Table 4: Statistical association of risk factors with PONV

In our study we observed a significant incidence of PONV, with key risk factors including female gender, intraoperative opioid use, and prolonged surgical duration. Out of 150 patients in the age group of 38.4 +/- 11.2, 55(36.7%) were male and 95(63.3%) were female. 100 (66.7%) patients were ASA grade I and 50 (33.3%) were ASA grade II. The overall duration of surgery was 72.5 +/- 18.6 minutes. Collectively, the incidence of PONV was higher in female patients with p-value 0.021 consistent with the existing literature that identifies female gender as a strong, independent predictor of PONV. Hormonal influences and increased sensitivity to anesthetic agents are thought to contribute to this predisposition.

The use of intraoperative opioid use was associated with a 95.2% incidence of PONV (p-value 0.037). Opioids act on chemoreceptor trigger zone and delay gastric emptying, both of which induce nausea and vomiting. Despite the prophylactic administration of ondansetron to all the patients, opioid-related PONV remained significant. This suggest that additional measure should be taken to prevent PONV in high-risk individuals.

Surgical duration exceeding 60 minutes also correlated with an increased PONV rate (85.7%) with p-value of 0.048. Longer surgeries increase the exposure to emetogenic stimuli such as volatile anesthetics.

The use of ondansetron, a 5-HT3 antagonist, in this study may have reduced the baseline incidence of PONV, however a considerable number of patients still experienced symptoms.

This study highlights that postoperative nausea and vomiting remain common complications after laparoscopic surgeries, with particularly high incidence in females, patients receiving opioids, and those undergoing prolonged procedures. Limitations of the study include its observational design and lack of long term follow up for delayed PONV.

Identifying patients at high risk for PONV enables clinicians to implement more effective, individualized prophylactic strategies. Incorporating multimodal antiemetic protocols can improve postoperative outcomes and patient satisfaction.

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