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VetVine Client Care
Postoperative Regurgitation And Vomiting In Dogs
Anesthesia & Analgesia
Postoperative regurgitation and vomiting (PORV) is undesirable in our veterinary patients. In addition to having an ill effect on patient well-being, it can also lead to prolonged hospitalization of patients after a procedure, which can lead to increased cost of treatment. PORV can also result in complications and undesirable outcomes including esophagitis, aspiration pneumonia, and increased tension on suture lines (associated with the retching).
Anecdotally, surveys of internal medicine specialists have indicated that the vast majority of esophageal strictures they have treated in their practice had developed after an anesthetic event.
Back in 2015, a study was published that summarized risk factors for PORV (postoperative regurgitation and vomiting) in dogs. This was a retrospective study that included dogs that had been referred for various non-elective orthopedic, neurologic and soft tissue surgeries. Many data points were evaluated including patient signalment, past medical history, anesthetic protocol, concurrent medications, and procedure type.
In total, 244 dogs were included in that study and the overall incidence of PORV was 12.3% (30/244 dogs). The highest risk factors for PORV found in that study were (from highest to lowest):
- GI surgery (42% of GI surgery patients developed PORV)
- Premedication with strong sedatives with α-agonists (Medetomidine or Acepromazine)
- ASA score of 4
- History of vomiting or regurgitation
- Emergency surgery (esp. GI surgery)
- Neurologic surgery
- Inhalation anesthesia (sevoflurane)
- Sexually intact
Other important findings ... dogs given corticosteroids before surgery had a significantly higher incidence of postop vomiting, and the incidence of regurgitation was significantly higher in dogs that received propofol as part of their anesthetic regimen.
The findings of this study confirmed that PORV is not uncommon and that antiemetic prophylaxis and preoperative administration of antacids should be considered - particularly in dogs undergoing GI surgery or when other risk factors are present. Cimetidine and ranitidine are reasonable considerations since they can be administered intravenously.
Reference: Incidence of and risk factors for postoperative regurgitation and vomiting in dogs: 244 cases (2000-2012) - JAVMA, Vol 246(3), Feb 1 2015, pp 327-335.