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Controlling Postoperative Nausea and Vomiting for Gastric Bypass Patients: Presented at ASA

By Arushi Sinha, PhD

SAN FRANCISCO, CA -- October 16, 2007 -- With the growing incidence of gastric bypass surgery, there is an accompanying need to better control the postoperative adverse effects of this procedure. As body mass index (BMI) increases, there can also be an associated increase in adverse events, including nausea and vomiting.

Research presented here on October 15 at the Annual Meeting of the American Society of Anesthesiologists (ASA) suggests that better control of nausea and vomiting may also reduce the incidence of postoperative pain.

Among a cohort of 15 patients undergoing laparoscopic gastric bypass surgery, researchers obtained records on the incidence of nausea and vomiting (or retching) after 1, 4, 24, and 48 hours of surgery. The average age of patients in the study was 46.8 years (standard deviation [SD]: 12.85; range: 27-66 years). The average BMI among the patient population was 52.93 kg/m² (SD: 11.97; range: 37-81 kg/m²).

The findings showed that at 1 hour, two patients experienced mild nausea without evidence of vomiting or retching. At the 4-hour time point, five patients exhibited nausea, and two experienced vomiting or retching. The highest incidence of nausea occurred at the 24-hour time mark, with 20% of patients experiencing vomiting/retching. Both sets of symptoms resolved within 48 hours.

"Clinical observation shows that there is a correlation between pain and nausea in patients undergoing gastric bypass surgery," explained one of the researchers, Ashish Sinha, MD, PhD, Assistant Professor, Department of Anesthesiology and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States.

With respect to the incidence of pain, which is a well-known stimulant for nausea and vomiting, the onset correlated with the timeframe of the other symptoms. Pain symptoms peaked at 24 hours and were much better tolerated at 48 hours.

Based on these findings, the researchers observed that nausea was more common than vomiting in these patients. In fact, the incidence of vomiting was almost negligible. "A 30 cc stomach volume may prohibit vomiting, and only result in retching," observed Dr. Sinha.

The researchers also suggested that pain may have a role in exacerbating nausea and vomiting after gastric bypass surgery.

"Obviously we are providing appropriate postoperative treatment as the incidence of adverse events decreases over time," explained Dr. Sinha. He added, "Maybe if we treat the pain appropriately, the incidence of nausea should also decrease."


[Presentation title: Incidence of Post Operative Nausea and Vomiting in the Extremely Obese After Weight Loss Surgery. Abstract A1053]

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