PONV are common causes of delayed discharge. PONV; nausea and/or vomiting in the first 24
hours after surgery. The incidence of PONV after elective surgeries varies between 30-80%
depending on anesthesia, type of surgery, and risk factors of the patient. PONV is not
only an uncomfortable complication for the patient but is associated with significant
patient dissatisfaction. It also includes dehydration, electrolyte imbalance, acid-base
imbalance, pulmonary aspiration, pneumothorax, hypoxia, esophageal rupture, increased
intracranial pressure, wound problems, bleeding, delayed oral intake, prolonged
hospitalization, fatigue, anxiety, unexpected hospital readmission, increased medical
costs. Therefore, the prevention and management of nausea and/or vomiting in the
perioperative period in surgical patients is very important.
In the preoperative period, patients' risk of nausea and/or vomiting should be evaluated
with standard measurement tools. The most commonly used is the Apfel risk score,
including four risk factors. These; female gender, history of PONV and/or motion
sickness, non-smoking, and postoperative opioid use. In the presence of 0, 1, 2, 3, and 4
risk factors, the incidence of PONV is approximately 10%, 20%, 40%, 60%, and 80%,
respectively. It has been observed that the use of risk scoring for PONV significantly
reduces the rate of nausea and vomiting in the postoperative period. The risk of PONV
varies depending on the patient, the type of anesthesia and the surgery. Female gender,
young age, non-smoking, history of PONV or motion sickness are important risk factors for
PONV. Type of anesthesia, duration of administration, use of volatile anesthetics and
nitrous oxide, and use of opioids in the perioperative period are among other risk
factors. It has been reported that PONV is seen more frequently after laparoscopic,
bariatric, gynecological surgery, and cholecystectomy.
In order to prevent the development of nausea-vomiting and aspiration pneumonia during
and after the operation, patients should be fasted for a certain period of time before
the operation. Fasting periods in the preoperative period should not be long enough to
cause adverse outcomes in patients. It has been reported in the literature that long
preoperative fasting periods do not prevent some complications, but on the contrary
increase them. Therefore, it is emphasized that it is unnecessary to starve patients for
a long time in the preoperative period. In the study of Hausel et al., it was reported
that patients who were fasted for 12-24 hours before surgery had more nausea and vomiting
in the postoperative period than patients who were fasted for a short time and were given
oral carbohydrate-containing fluids. According to the results of different studies
conducted in this area, it has been reported that reducing the preoperative fasting
period eliminates the patient's feeling of thirst before the operation, reduces nausea
and vomiting, alleviates anxiety, increases patient comfort, accelerates recovery, and
significantly shortens the length of hospital stay. It is stated that a short
pre-operative fasting period reduces the loss of nitrogen in the urine and prevents loss
of muscle strength, reduces the feeling of anxiety and thirst before the operation, and
increases patient comfort by reducing nausea and vomiting in the early postoperative
period. It has been reported that there are limited clinical studies to explain the
relationship between perioperative fasting time and PONV in terms of the level of
evidence. In this respect, it is important to determine the relationship between risk
factors preoperative fasting times, and PONV.