{"id":11026,"date":"2017-05-10T18:51:04","date_gmt":"2017-05-10T16:51:04","guid":{"rendered":"https:\/\/eoc.cat\/nauseas-y-vomitos-paciente-postquirurgico\/"},"modified":"2022-02-17T10:52:14","modified_gmt":"2022-02-17T09:52:14","slug":"nausees-vomits-pacient-postquirurgic","status":"publish","type":"post","link":"https:\/\/eoc.cat\/ca\/nausees-vomits-pacient-postquirurgic\/","title":{"rendered":"N\u00e0usees i v\u00f2mits en el pacient postquir\u00fargic"},"content":{"rendered":"

Dels milions d’operacions sota anest\u00e8sia que es fan a tot el m\u00f3n se sap que aproximadament un de cada quatre pacients patir\u00e0 de n\u00e0usees i v\u00f2mits perioperatoris (NVPO). Aquesta \u00e9s una de les complicacions m\u00e9s temudes havent rebut fins i tot el nom de \u00abEl petit gran problema\u00bb. De fet, entre les primeres causes de por a la cirurgia cohabiten, a m\u00e9s, la por del dolor, el despertar durant l’acte operatori i no despertar-se.<\/p>\n

Abans de comen\u00e7ar seria interessant remarcar les difer\u00e8ncies entre tres processos fisiol\u00f2gics relacionats: n\u00e0usees, arcades i v\u00f2mits. Si b\u00e9 poden estar relacionats poden presentar-se de manera individual.<\/p>\n

Les n\u00e0usees s\u00f3n una sensaci\u00f3 subjectiva desagradable a nivell de l’epigastri associada a la imminent necessitat de vomitar. Pot ser un pr\u00f2drom i acabar en un veritable v\u00f2mit: expulsi\u00f3 del contingut g\u00e0stric a trav\u00e9s de la boca, en contra dels moviments perist\u00e0ltics. Tamb\u00e9 rep el nom d’emesi a l’\u00e0mbit sanitari. Les contraccions r\u00edtmiques dels m\u00fasculs respiratoris reben el nom d’arcades.<\/p>\n

L’emesi est\u00e0 controlada pel centre del v\u00f2mit en la formaci\u00f3 reticular del bulb raquidi. Aquesta pot ser excitada mitjan\u00e7ant quimioreceptors que poden accionar-se per subst\u00e0ncies presents a la sang com els opioides. No obstant aix\u00f2, existeix tamb\u00e9 l’estimulaci\u00f3 a trav\u00e9s del sistema vestibular a l’orella (marejos i vert\u00edgens com en un viatge amb cotxe), a trav\u00e9s del nervi vague (irritaci\u00f3 far\u00edngia) o el sistema nervi\u00f3s vagal i ent\u00e8ric (alteracions de la mucosa gastro- intestinal).<\/p>\n

Al pacient conscient podem observar una salivaci\u00f3 augmentada, augment del ritme card\u00edac i sudoraci\u00f3. En aquests casos, la glotis es tanca per evitar l’entrada de contingut estomacal a la via a\u00e8ria i es relaxa l’esf\u00ednter gastroesof\u00e0gic. Aix\u00ed, despr\u00e9s de la contracci\u00f3 de la musculatura tor\u00e0cica i abdominal, el contingut g\u00e0stric \u00e9s expulsat.<\/p>\n

Etiologia i susceptibilitat a les n\u00e0usees i v\u00f2mits<\/h2>\n

Aquesta complicaci\u00f3 t\u00e9 una alta incid\u00e8ncia al postoperatori. Els NVPO es presenten en un 9-10% a URPA (Unitat de Reanimaci\u00f3 Post-Anest\u00e8sica o \u201csala de despertar\u201d) fins a superar un 30% en les primeres 24 hores.<\/p>\n

Si b\u00e9 qualsevol pacient n’\u00e9s susceptible, se sap que determinats pacients (sexe femen\u00ed, no fumadors, historial previ de mareigs i n\u00e0usees per moviment, cirurgies ginecol\u00f2giques, abdominals o correctores d’estrabisme) s\u00f3n m\u00e9s propensos i que altres factors com deshidrataci\u00f3, dolor no controlat correctament, ansietat, hipotensi\u00f3 i dejuni s’ha vist que poden augmentar la seva freq\u00fc\u00e8ncia i encara \u00e9s utilitzada l’escala d’Apfel per a la seva valoraci\u00f3.<\/p>\n

El tipus d’anest\u00e8sia tamb\u00e9 t\u00e9 una alta influ\u00e8ncia, i l’administraci\u00f3 d’opioides, determinats anest\u00e8sics intravenosos (Etomidato i Ketamina) o gasos anest\u00e8sics els han vist relacionats amb una incid\u00e8ncia m\u00e9s gran.<\/p>\n

Complicacions de la NVPO<\/h2>\n

Dins de les complicacions secund\u00e0ries es troben el dolor, dehisc\u00e8ncia de ferida, formaci\u00f3 d’hematomes, augment de costos, retard a l’alta i risc de broncoaspiraci\u00f3. Sense oblidar, la part emocional, ja que el pacient ho percep com una cosa summament desagradable.<\/p>\n

 <\/p>\n

Avui dia va guanyant terreny el Propofol, ja que ha demostrat tenir propietats antiem\u00e8tiques intr\u00ednseques. Si b\u00e9 \u00e9s cert, t\u00e9 un cost elevat en comparaci\u00f3.<\/p>\n

Tractament i cura d’infermeria del T\u00e8cnic de Cures Auxiliars d’Infermeria (TCAE)<\/h2>\n

Tot i aix\u00f2 no existeix evid\u00e8ncia de la necessitat d’una profilaxi antiem\u00e8tica generalitzada de forma concomitant amb els anest\u00e8sics i \u00e9s tasca de l’anestesi\u00f2leg prescriure’l durant la visita preoperat\u00f2ria.<\/p>\n

Cal tenir en compte que en cirurgies programades, el contingut g\u00e0stric \u00e9s inexistent. En cirurgies urgents l’anestesi\u00f2leg prendr\u00e0 precaucions per assegurar la permeabilitat de la via a\u00e8ria i evitar risc de broncoaspiraci\u00f3.<\/p>\n

En aquest context, les cures d’infermeria a aplicar per part del TCAE<\/a> han de ser assegurar la relaxaci\u00f3 del malalt i el seu confort, acompanyar-lo i sostenir-lo durant el v\u00f2mit mantenint-lo polit i confortable, seguir les ordres prescrites quant a reintroducci\u00f3 de l\u00edquids i s\u00f2lids, anotar qualsevol v\u00f2mit i les seves caracter\u00edstiques, mantenir el pacient en posici\u00f3 de Fowler si \u00e9s compatible amb el seu estat o amb el cap decantat si no fos possible, evitar olors fortes que poden augmentar la sensaci\u00f3 n\u00e0usea, humitejar els llavis amb una gasa si no es pot reiniciar ingesta l\u00edquida i si hi ha un mal control del dolor referir-ho al DUE responsable.<\/p>\n

Ara ja saps una mica m\u00e9s sobre com procedir davant d’un pacient amb n\u00e0usees i v\u00f2mits despr\u00e9s d’un postoperatori. Si vols m\u00e9s informaci\u00f3 no dubtis a consultar aquesta bibliografia:<\/p>\n

Bibliografia recomanada<\/h2>\n

CASTELL F, Erick, HERNANDEZ N, Valentina, QUINTANA P, Carolina et al. Prevenci\u00f3 i tractament de n\u00e0usees i v\u00f2mits postoperatoris. Quad. cir. (Valdivia), 2011, vol.25, no.1, p.75-80. ISSN 0718-2864. FISHER DM. The \u201cBig little problem\u201d of postoperative nausea and vomiting: do know the answer yet? Anesthesiology. 1997;87:1271-1273<\/p>\n

Escrit per: Aranzazu,\u00a0\u00e9s Llicenciada en Biologia i Doctorada en Ci\u00e8ncies de la Salut. Imparteix el Curs d’Auxiliar de Quir\u00f2fan<\/a> a l’Escola d’Oficis Catalunya.<\/p>\n","protected":false},"excerpt":{"rendered":"

Dels milions d’operacions sota anest\u00e8sia que es fan a tot el m\u00f3n se sap que aproximadament un de cada quatre pacients patir\u00e0 de n\u00e0usees i v\u00f2mits perioperatoris (NVPO). Aquesta \u00e9s una de les complicacions m\u00e9s temudes havent rebut fins i tot el nom de \u00abEl petit gran problema\u00bb. De fet, entre les primeres causes de […]<\/p>\n","protected":false},"author":7,"featured_media":11027,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"categories":[88,91],"tags":[89,92],"class_list":["post-11026","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-auxiliar-infermeria","category-auxiliar-quirofan","tag-auxiliar-infermeria","tag-auxiliar-quirofan"],"yoast_head":"\nN\u00e0usees i v\u00f2mits en el pacient postquir\u00fargic | EOC<\/title>\n<meta name=\"description\" content=\"El TCAE ha de saber tractar el pacient postquir\u00fargic. 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