Risk factors

Risk factors in adults:

- More common in women
- Often in people who do not smoke

The risk factors in children:

- Surgery is more than 30 minutes
- More common in older than 3 years
 Multimodal approach to pain
management
Until now, the gag reflex is still believed to be regulated by the
vomiting center in the brain, which receives some afferent
input. Vagus nerves got the intake of the intestine can activate
the vomiting center and also the afferent action of CTZ.
Chemoreceptor trigger zone itself is outside the blood brain
barrier and has several different receptors to activate them.
Most of antiemetic drugs work directly or indirectly on these
receptors.
 Some receptors can lead to vomiting, it is
natural that it takes a combination of drugs
may work on some receptors compared to
only one drug that works on one receptor.
Increasing the dose of the drug will not reduce
the incidence of postoperative nausea and
vomiting, especially in high-risk patients.
 Also keep in mind that the side effects
increase with increasing doses Therefore
multimodal approach offers many advantages
and reduce the occurrence of side effects due
to increasing doses, but there is a risk of drug
interaction effects.
 Pathophysiology of pain
The mechanism underlying the emergence of neuropathic
pain are: peripheral sensitization, ectopic discharge,
sprouting, central sensitization, and disinhibition. Changes in
the expression and distribution of sodium and potassium ion
channels occurs after nerve injury, and increase the
excitability of the membrane, so that it appears ectopic
activity are responsible for the spontaneous emergence of
neuropathic pain