How likely is vomiting after rhinoplasty, and what preventative measures can the surgeon take?

Question

I have emetophobia, which means I'm terrified of all things pertaining to vomit. I have wanted a rhinoplasty for years since breaking my nose as a child, but I'm too afraid of the possibility I'd be ill afterwards.

Oakley Smith, MD, FRCSC · Answer

Vomiting unfortunately can occur after any surgery. Certain surgery however are know to increase the likelihood. Rhinoplasty is one of them (the others are eye, ear, urologic and gynecologic surgeries). Certain people are know to have a higher chance of vomiting. Women, children, being overweight, pre-op anxiety, motion sickness are all risk factors.Both nausea and vomiting occur about 25% of the time after surgery. With Rhinoplasty, it's over 50%. The reason is blood and your stomach don't agree. Unfortunately blood trickles down the back of your throat during Rhinoplasty.What can be done to help reduce this? Good surgical technique certainly helps. So do medications which are commonly, even routinely given at the time of surgery (Dexadron, Ondansetron, Gavol are a few). Some anesthetic drugs are know to be associated with vomiting, so they can sometimes be avoided. Finally using the least amount of narcotics afterwards can help as these are known to increase nausea and vomiting in many people.

Jeffrey Cone, MD · Answer

Emetophobia is a worthwhile point to bring up with your Plastic Surgeon prior to surgery, but several steps can be taken to minimize the risks of nausea (and vomitting) post-operatively.  The main risk factors for Post-operative Nausea and Vomitting (referred to as PONV) are 1) female gender, post-puberty, 2) non-smoking status, 3) history of PONV or motion sickness, 4) age between infancy and younger adulthood, 5) increasing duration of surgery, and 6) use of volatile anesthetics, nitrous oxide, large-dose neostigmine, or intraoperative or postoperative opioids.You'll notice that, as a patient, most of these risk factors are out of your control, including gender, history of motion sickness, age, etc.  That said, great options exist to minimize the risk, and it is important to let your surgeon and anesthesiologist know prior to surgery of your concerns.  Steps include taking anti nausea medication the night before surgery (our practice uses Emend), medication the morning of surgery (such as Zofran and Decadron), minimizing certain anesthetics (discuss with your anesthesiologist), surgical techniques to minimize bleeding from the nose and down into the stomach (which can create nausea), and lastly, minimizing the amount of narcotic pain medications that you take after surgery (since narcotic-based pain meds can make one nauseated).  The above precautions are helpful to anyone with a high risk profile for PONV, but as a person who suffers from Emetophobia, consider seeking out the help of a psychologist who can also provide you with helpful coping techniques.  Rhinoplasty is a gratifying procedure, and your phobia doesn't have to stand in the way. As with most phobias, a little education and training can go a long way. Cheers.

R. Stephen Mulholland, MD (retired) · Answer

Dear LP03,

Thank you for your excellent clinical question and, in fact,
vomiting after rhinoplasty is not uncommon. 
There are several reasons for this, but the two most common would be a
reaction of nausea and vomiting to the use of narcotic medication.  Narcotics, although good for pain, cannot
cause nausea and vomiting, so avoiding use of strong narcotics is known to
cause these types of symptoms should be avoided.

One of the other reasons for vomiting after rhinoplasty is
that a significant amount of blood, especially at the time of infractures or
septum surgery can flow backwards into the stomach.  This can create a nauseated sense and result
in initial vomiting in the first few hours after the surgery.

Preventatively it is important that you have a healthy
well-balanced diet and that you take some modest supplements to improve wound
healing and this can be discussed with your medical aesthetician.

I hope this information has been of some assistance and best
of luck.

For more information, please review the link below.

R. Stephen Mulholland, M.D.

Certified Plastic Surgeon

Yorkville, Toronto

How likely is vomiting after rhinoplasty, and what preventative measures can the surgeon take?

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How likely is vomiting after rhinoplasty, and what preventative measures can the surgeon take?

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Everything you need to know about Rhinoplasty

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