Severe intraoperative nausea and vomiting (IONV) these are common intraoperative events that give discomfort and disturbed feelings to patient after anesthesia. 

Use of volatile agents is responsible for feeling of nausea and vomiting. Opioids are used to control severe pain during intra and post-surgery. 

Intervention in the gastrointestinal tract and laparoscopic surgery are responsible for increasing the risk. 

History of motion sickness or previous episodes of postoperative nausea and vomiting cases are important factors. 

IONV impacts 10% to 30% in surgery patients due to surgery type and anesthesia.  

High-risk patients should be identified and provided with targeted prophylactic measures to reduce the incidence rate. 

Dopamine receptors are involved in the emetic response. Some drugs and surgical stimuli affect dopamine levels and receptor activity to cause nausea and vomiting. 

Use antiemetic drugs before and during surgery to manage and prevent severe IONV. 

CTZ in medulla oblongata sensitive to toxins and blood chemicals. Vestibular system disruption during inner ear surgeries or sudden body position changes can induce nausea. 

Surgery of the abdominal organs can cause gastric distension or irritation to stimulate the vagus nerve. 

The IONV cases increased discomfort, prolonged recovery times, and more healthcare costs. It also affects the surgical outcome and patient satisfaction. 

• Causes of Severe intraoperative nausea vomiting as: 
• Anesthetic Factors 
• Volatile Anesthetics 
• Local Anesthetics 
• Type of Surgery 
• Duration and Complexity 
• Patient Characteristics 
• Physiological and Biochemical Factors 

Patients under 50 years old and premenopausal women have increased risk of IONV during treatment. 

Total intravenous anesthesia related to less IONV than inhalational anesthetics during surgery. 

Increased risk during laparoscopic procedures with GI manipulation. 

Gastrointestinal sensitivity increases risk for postoperative nausea. 

The clinical history of postoperative nausea and vomiting includes preoperative history and intraoperative events.  

• Abdominal Examination 
• Neurological Examination 
• Cardiovascular Assessment 

Symptoms are: 

• Nausea and vomiting  
• Dehydration 
• Electrolyte imbalances 

Use anesthetic agents to lower the risk of nausea and vomiting. 

Using total intravenous anesthesia agents to reduce the risk compared to volatile anesthetics. 

Avoid volatile anesthetics and nitrous oxide if the patient is at high risk for nausea vomiting. 

Daily monitor vital signs to detect and address any changes in nausea and vomiting. 

Consider non-opioid analgesics and regional anesthesia techniques to control pain. 

Administer postoperative antiemetics based on the severity and persistence of symptoms including 5-HT3 Receptor Antagonists, dopamine antagonists, and corticosteroids. 

Surgery, General

Maintain a comfortable temperature in the operation room to avoid nausea through discomfort. 

Extreme temperatures can affect patient comfort and contribute to nausea. 

Regular physical activity to improve overall well-being and reduce stress. 

Regular sleep schedule with consistent bedtimes should be maintained. 

Proper awareness about SINV should be provided and its related causes with management strategies. 

Appointments with a physician and preventing recurrence of disorder is an ongoing life-long effort. 

Surgery, General

Ondansetron: 

It blocks serotonin receptors in the gastrointestinal tract and the central nervous system. 

Surgery, General

Metoclopramide:  

It blocks dopamine receptors in the central nervous system to control nausea and vomiting. 

Surgery, General

Dexamethasone: 

It reduces inflammation to prevent nausea that affects various pathways involved in the emetic response. 

Surgery, General

In severe intraoperative nausea and vomiting cases timely and effective interventions are essential to minimize impact on the surgical procedure. 

Patient positioning should be adjusted to reduce intra-abdominal pressure and discomfort. 

Surgery, General

In the initial assessment phase, evaluation of history of nausea and vomiting, motion sickness, and current medications to confirm diagnosis. 

Pharmacologic therapy is effective in the treatment phase as it includes use of 5-HT3 Receptor Antagonists, Dopamine Antagonists, and corticosteroids. 

In supportive care and management phase, patients should receive required attention such as lifestyle modification and intervention therapies. 

The regular follow-up visits with the physician are scheduled to check the improvement of patients along with treatment response.