My husband is a disabled internal med/pulmonary physician. In the past I have had a problem with nausea and low BP post-surgery. My husband thinks it is the epinephrine, based on an experience with the removal of a cyst on my back. The surgeon was removing it with a local in his office while dripping a little epinephrine in the wound. I got so sick I thought I was going to die. Compazine helped and he was able to finish the removal. I had a chole in 2001 and was kept over night because of the extreme nausea. The surgeon handed me a list of 7 different meds the next day he had used to control the nausea. I have no memory of the recovery room. The list included phenergan, zofran, compazine etc. I have had numerous surgeries and I need to have a back procedure but am very fearful. Is there a way to sort this out? 

ﾠWith only a fragmentary history all I can offer you is some general remarks about post-operative nausea. Firstly it is relatively common. Second, it can usually be controlled, or at least reduced in intensity and duration. 

Your anesthesiologist needs the details of what has happened to you previously (hospital records including anesthesia records would be ideal) and can plan the anesthesia and postoperative care accordingly. 

Low blood pressure can cause nausea so your doctors need to know what caused the low blood pressure (many possible causes). 

Antiemetic (anti-nausea) medications can be given to prevent or treat nausea - these include ondansetron, dexamethasone, droperidol, Compazine, and Phenergan, and others. Acupressure, or electrical acupuncture point stimulation can help, as can intravenous fluids, extra oxygen (maybe), avoidance of nitrous oxide and of excessive opioids (pain-killers like morphine). 

Local anesthetic infusion in the skin incision can help with pain and therefore reduce the amount of pain killer-related side-effects, which includes nausea. Your anesthesiologist is the best person to decide which combination of antiemetics and which anesthesia technique or combination of techniques and strategies will will give you the safest and most comfortable result from your back procedure. 

I have had two outpatient surgeries. One was in 1984 for a D&C. Immediately after waking up, I developed nausea. I was released but threw up in a trash can on way home. Developed dry heaves as there was nothing in my stomach. Could not even keep water down. They called in a suppository and that finally took care of the problem. My second surgery was in 1994 for foot surgery. Woke up on the table as they were completing surgery. I was to be discharged in a couple of hours. Started being sick on my stomach immediately. In recovery I began shaking uncontrollably and was admitted. I do not know what they gave me to help with the problem but I was discharged the next day. The hospital is no longer in operation so I do not have my records from that stay. I am 59 years old and am scared to have any procedure that involves anesthesia. As a child I did have a problem with motion sickness but that seems okay now but do have a vertigo problem that acts up usually once or twice a year. Do not know what activates it but last time it was traced to a routine visit to the dentist and my head was lower than my feet for a good while and they thought that could have been responsible for the vertigo. I don`t know if that could be the problem when having surgery. Can you give me any advice or tests that should be done for any procedure I might need that involve anesthesia? I have been putting off a colonoscopy because of this. 

Postoperative nausea and/or vomiting - abbreviated PONV in medical journals - is still a surprisingly common condition. You've given an excellent description of what can happen and how unpleasant it is. In fact, it's the kind of description that I might use in a lecture on the subject! There are a few well known risk factors that make a person more likely to experience PONV. These risk factors include young age, female sex, gynecologic surgery, and a history of motion sickness, so it's not surprising that as a woman aged 38 or so you had PONV after your D&C! Many patients are okay in the hospital but become nauseous during the ride home, as you did. You were nauseous after your foot surgery also and were treated for it. At that time you were probably given a drug called droperidol, or a related drug called metoclopramide. Both of these drugs are known to occasionally cause quite a nasty side-effect of uncontrollable shaking or rigid muscles. This is known as an "extrapyramidal" reaction. This kind of reaction may occur again if you receive those drugs again so you should probably avoid them. A common cause of vertigo is a condition called benign paroxysmal vertigo. I believe that nausea may accompany the vertigo symptoms, but I am not sure that there is any relationship between this condition and PONV and I cannot recommend any specific tests. Today, colonoscopies are done with a variety of sedative medications. I have answered several questions in the past about these methods, so you can browse the questions on the NetWellness website. Colonoscopy accompanied by sedation with an agent like propofol is usually very safe, relatively comfortable and has a low incidence of PONV. You are twenty years older now and your risk of PONV is much lower - perhaps one of the few benefits of aging! You should tell your anesthesiologist about your history of PONV. You may be given an anti-nausea drug along with the sedative medications. Newer anti-nausea drugs do not cause extrapyramidal reactions. Examples include ondansetron, dolasetron, and granisetron - the "trons"! 

My 75 yr old mother has had non-stop nausea following an operation. She has had 3 stents placed in the last 4 months. One procedure for stenosis of the superior m. artery. She has had imaging of her abdomen, CT of head, blood work, endoscopy and biopsies. She has just had a colonoscopy w/no results to explain her ongoing nausea. Could anesthesia from June still be affecting her? 

It's very unlikely that your mother's anesthesia has anything to do with her ongoing nausea. It is best that she consult her regular physician, as ischemia (reduced blood supply) of the bowel could be responsible. 

I am to have surgery in a couple days under general anesthesia. I have received the usual warning of nothing to eat or drink after midnight before the surgery. The last time I had surgery I had quite a bit of vomiting afterwards. Are there any foods that should be avoided in the day or two prior to anesthesia? I understand why you shouldn`t eat prior to receiving the anesthesia, but is there things you could do diet-wise to help the recovery afterwards? Foods to not have had recently in your system? 

ﾠThe reason why you should not eat before a surgical procedure is that during anesthesia the contents of your stomach may come up your esophagus (food pipe) and spill into your lungs. This is called `aspiration` and can be a serious complication, even potentially fatal. While you are awake the body has reflexes that prevent aspiration. These protective reflexes are not present during general (asleep) anesthesia. The issue of whether specific foods reduce (or increase) nausea or vomiting after surgery has been studied very little. In one study, powdered ginger root (Zingiber officinale) taken before surgery was as effective as anti-nausea medication, but in others it was ineffective. I am not aware of any other foods, herbs or natural substances that are effective in preventing this problem. Avoiding dehydration before surgery may be helpful. Clear fluids, such as water, tea and apple juice pass throughout the stomach quickly and will help maintain your hydration. Solid food, particularly fatty foods, take a long time to clear (for your body to digest). Check with your anesthesiologist for guidelines on what is allowed before surgery, and how long before surgery you should stop all intake. Try to ensure a reasonable fluid intake up to that point. The guidelines for this are changing and becoming more liberal - see the American Society of Anesthesiologists web site for details. After your surgery you should follow the guidelines provided by your physicians. Obviously you should avoid a heavy meal immediately after surgery, and take things slowly but apart from that I cannot provide you with any specific recommendations. Please consult with your anesthesiologist before consuming any special foods, fluids or medications before your surgery. The type of surgery, and other medical conditions you may have, will also be an important influence on how you are treated. 

The past two times that I`ve had anesthesia administered, I`ve gotten severe nausea and vomiting for several hours after the surgery. Is it that I`m sensitive to anesthesia and should I let my physician know about this? 

You may be one of those individuals - usually younger, female, non-smokers, with much more risk of post-operative nausea and vomiting. You should definitely let your physicians know about thisﾠ most unpleasant problem. It may not be possible to eliminate it entirely but there are techniques for reducing the risk quite a bit.