they don't break like glass, but they bruise easily.

The prospect of an anaesthetic often conjures thought of violent vomiting and nausea. For some people this all too common side effect is worse than the surgical procedure they are undergoing. Now fortunately due to advanced research and new techniques, developments in antiemetic drugs have ceased this gut wrenching reaction to the anaesthetic.Anaesthetists at the Royal Melbourne Children's Hospital are particularly aware of this devastating side effect, particularly with children. Dr Rod Westhorpe from the hospital's Anaesthetic Department says researchers still do not really know what anaesthesia does to the body. "There are a number of different drugs which we use to provide a state of anaesthesia. Many of them act in different ways, with the primary effect being the depression of the brain to the point of unconsciousness, so the patient is not aware of what is going on, and they do not respond to pain and other stimuli," said Dr Westhorpe. He said many of the agents used to anaesthetise a patient have some mild side effects. "There may be a small drop in the blood pressure, or there may be involuntary movement of the muscles. One of the side effects is the tendency to induce nausea and vomiting, particularly post operatively." He said this side effect has no relation to the patient's requirement to fast before surgery. "Fasting times are down to a bare minimum. Some patients are actually allowed to have clear fluids up until two hours before an operation. We pay more attention to this in a Children's hospital, because adults can go without food and fluid for quite a long time, and they can tolerate being hungry. Whereas children don't tolerate hunger very well. Small infants, without food or fluid, can actually become dehydrated, or develop a low blood sugar." Some surgical procedures are more likely to induce vomiting. "Operations on the eye, ear, throat and also the groin are all more likely to induce vomiting," said Dr Westhorpe. His colleague Dr George Chalkiadis, says women undergoing gynaecological procedures have problems with nausea and vomiting. There are several influencing factors, including components of the anaesthetic that can induce this side effect. Also the drugs used for pain relief. "The traditional morphine, and morphine type drugs are very potent stimulators of nausea and vomiting. We are looking now at substitutes for these drugs which are less likely to produce vomiting," said Dr Westhorpe. "We are also using other new drugs, which are better for preventing or treating nausea, if it occurs." Pain relief is obtained with other means, including regional or local anaesthetic drugs, and non-opioid, and anti-inflammatory drugs. One on the most commonly used is indomethacin. "This is an anti-inflammatory drug, so it reduces inflammation, therefore tends to reduce inflammation at the wound site and reduces pain," said Dr Chalkiadis. "But it does have a problem, limiting its use, as it can cause ulcers of the stomach. Paracetamol is another mild non-opioid analgesic. This has been shown to reduce the level of opioids a patient may require." A patient is often started on opioids during a procedure, and then given paracetamol before the opioids have worn off. The introduction of paracetamol, reduces the pain and maintains the level of comfort, without the need for constant opioids. "There is a new era, in post operative management. There is a new group of antiemetic drugs, for the prevention or treatment of nausea and vomiting which seem to be much more effective. But they are not effective in every patient. Patients all react in different ways. For many these new drugs like ondansetron, and tropisetron are very effective," said Dr Westhorpe. These drugs block the receptors in the brain, which induce the nausea and vomiting. They are also very effective and revolutionary in the treatment of cancer, combating the vomiting side effect of chemotherapy. He said in the past post-operative antiemetic drugs have been used with a shotgun approach. In the past up to sixty percent of patients undergoing certain operations would suffer post operative nausea and vomiting. With new drugs methods of anaesthesia, this has reduced to just under 10 percent, including high-risk patients, (patients prone to motion sickness). "We want to see our patients, comfortable and getting back to every day life as soon as possible. A lot of our thrust in anaesthesia is to that result." Dr Westhorpe says this control of vomiting and nausea helps a patient's recovery. "It could be quite disastrous depending on the operation, if a patient, is heaving and gut wrenching, and stretching suture lines. If they spend most of the night vomiting, it takes them another day to recover, before they are able to drink fluids." With nausea, vomiting and pain relief now more effectively controlled, patients are able to recover more rapidly from an operation, and even return home the same day. For most patients vomiting after an anaesthetic is now a side effect of by gone days. "The future for patients having an anaesthetic is really promising, and it can only get better," said Dr Westhorpe.

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