The various treatments in the digestive sector are often assisted by anaesthesia, but the problem of post-aesthetic vomiting (PONV) is more common and affects patients and medical personnel. Understanding new developments in their prevention and treatment is essential to improve patient forecasting.
I. A new understanding of PONV ‘ s morbidity mechanism
(1) The function of neurotransmitters
Various neurotransmitters were found to be involved in PONV. Of these, dopamine, 5-Oxylene, ammonium and acetyl choline play a key role in the vomit central and chemical sensor trigger. For example, receptors of 5-Hypoxymethamphetamine (3-5-HT3) are widely present in gastrointestinal ecstasy into fibre and central nervous systems, which can trigger vomit reflection when irritated. This provides a target-point basis for the development of new anti-pubration drugs.
(2) Gastrointestinal disorders
Anaesthesia can affect the creeping and emptiness of the gastrointestinal tract. The digestive surgery or operation itself may also stimulate the gastrointestinal tract, resulting in an abnormal gastrointestinal drive. Post-operative gastrointestinal hormones are imbalanced, such as reduced gastrokinesis and increased gastrogen.
II. A new strategy for PONV prevention
(1) Preventive measures related to anaesthesia
1. Drug choice
New types of short-activated, gastrointestinal irritating small narcotic drugs were selected. For example, some new formulations of inhaled anaesthesia have led to a relatively low incidence of PONV. The risk of PONV, which is lower than inhaled, has been shown in a number of studies, based solely on intravenous anesthesia (TIVA), especially when propol is used to maintain anaesthesia.
2. Anaesthesia depth management
The depth of the anaesthesia is precisely controlled through advanced techniques for the monitoring of the depth of anaesthesia, such as the Brain Double Frequency Index (BIS). To avoid anaesthesia too deep or too shallow and to reduce the PONV caused by an improper depth of anaesthesia.
(2) Drug prevention
Multi-modal stop-off programme
Joint use of various mechanisms such as 5-HT3 receptor constrictor, Disemyson, Neuro-Etraction 1 (NK-1) receptor constrictor, etc. This multi-modal approach can increase prevention effectiveness by inhibiting vomit reflection in several ways. For example, in high-risk PONV patients, PONV incidences can be significantly reduced by pre-operative giving Palonoxian (5-HT3 receptors) and Disemison.
2. Development and application of new drugs
A number of new types of anti-opaque drugs are emerging, such as the NK-1 receptor, which is being used more widely. By inhibiting NK-1 receptors, it effectively interrupts the transmission of vomit signals, particularly in the context of prophylactic delayed vomiting.
(3) Non-drug prevention
Certain caves such as needles have shown some effectiveness in preventing PONV. Its mechanisms may be related to the regulation of neuroendocrine and gastrointestinal functions. A number of studies have shown that needle sting therapy can be used as an aid to prevention and to reduce the use of anti-oppressants.
III. New developments in PONV processing
(1) Timely assessment and diagnosis
When the patient appears at PONV, the severity of the symptoms, the frequency of the symptoms, whether they are accompanied by abdominal pain, abdominal swelling, etc. are promptly assessed. At the same time, consideration needs to be given to the existence of factors that may increase vomiting, such as low blood pressure and oxygen deficiency, for targeted treatment.
(2) Drug treatment adjustment
1. Optimization of the use of anti-smoking drugs
Depending on the patient ‘ s specific circumstances, the type and dose of anti-pussic drugs are adjusted. If the initial prevention programme is not working well, other mechanisms of action can be replaced with an anti-spam or an increase in the dose. For example, NK-1 receptors can be added to those who vomit after the use of 5-HT3 receptors.
2. Co-medicine and sequence treatment
Use of combination or sequenced treatment. The use of rapid-acting drugs to mitigate acute vomiting is followed by the use of long-acting drugs to prevent relapse into vomiting. At the same time, attention is paid to the interaction between drugs and to avoiding an increase in adverse reactions.
(3) Support for treatment
1. Liquid recovery and electrolyte balanced vomiting can lead to dehydration and electrolyte disorders in patients, timely liquid recovery, supplementing lost moisture and electrolyte and maintaining internal environmental stability. (c) Rational adjustment of the rehydration composition and quantity based on blood-gas analysis and electrolyte examination results.
2. Nutritional support is provided through intestine or intestine nutrition for patients whose continuous vomiting affects food intake. Selecting the appropriate nutritional formulation to ensure the nutritional needs of the patient during recovery and to promote the recovery of gastrointestinal function.
New developments in the prevention and treatment of vomiting after anaesthesia in the digestive section have continued. A better understanding of their morbidity mechanisms, a precise risk assessment and a multi-modal prevention strategy, as well as timely and effective treatment measures following the emergence of PONV, can significantly reduce the incidence and severity of PONV and improve the comfort and quality of rehabilitation of patients after treatment in digestive medicine. These new developments should be followed closely by health personnel and applied in clinical practice.
