There is acorrelation between the GA and phase of menstruation. Proven with a studyby Dr.Mridul Panditrao and his team.

1. Anaesthesiology
THE INCIDENCE OF
POSTOPERATIVE NAUSEA AND
VOMITING IN WOMEN
UNDERGOING SURGERIES UNDER
GENERAL ANAESTHESIA DURING
DIFFERENT PHASES OF
MENSTRUAL CYCLE
Presenting author
DR ADITI PANDITRAO
Co authors
Dr (Mrs) MM PANDITRAO Dr. IMRAN AZHER
Dr MM PANDITRAO

2. Anaesthesiology
1. INTRODUCTION
2. AIM AND OBJECTIVES
3. MATERIAL AND METHODS
4. DISCUISSIONS
5. RESULTS
6. CONCLUSION

3. Anaesthesiology 27 Dec2008
INTRODUCTION
ETIOLOGICAL FACTORS
PATIENT RELATED FACTORS
Age
Gender
obesity
H/O previous PONV
Anxiety
Smokers
PREOPERATIVE FACTORS
Food
Phsycological stress
PERIOPERATIVE FACTORS
Pre medication
Gastric distention and suctioning
Pharyngeal stimulation by supraglottic devices.

4. Anaesthesiology
INTRAOPERATIVE FACTORS
Anaesthetic factors-
IV anaesthetic agents
Inhalational agents
Surgical factors-
duration
Type of surgery
POSTOPRERATIVE FACTORS
Pain
Dizziness
Ambulation
Oral intake

5. Anaesthesiology
AIM AND OBJECTIVES
1. To find out the incidence of PONV during different phases
of menstrual cycle in patients undergoing surgeries under
general anaesthesia.
2. To compare the two if there is any difference.

6. Anaesthesiology
MATERIALS AND METHODS
• Approval of the institutional ethical committee.
• 60 ASA I and II patients.
• Normal menstrual cycle.
• Age between 18-45 years.
• Elective surgery under GA, duration of surgery 30 min- 3 hrs.
• Depending on date of LMP, classified as
MENSTRUAL GROUP (day 1-8)
NON MENSTRUAL GROUP ( day 9-28)
EXCLUSION CRITERIA
• HO hypertensive or cardiovascular disease.
• HO allergic to anaesthetic drugs.
• Post menopausal, pregnant patients and patients with menstrual
disturbances.

7. Anaesthesiology
PREANAESTHETIC EVALUATION
Pre op check up
Vitals
LMP
PREANAESTHETIC MEDICATION
inj Atropine .6mg iv
inj Fentanyl 2mics/kg or inj Butorphanol 1mg iv
inj midazolam 1mg iv

8. Anaesthesiology
INDUCTION AND MAINTAINENCE
. Preoxygenation 100% oxygen
. Thiopentone (titrated to loss of eyelash reflex).
. Succinylcholine 2mg/kg body wt.
. Laryngoscopy and intubation.
. Muscle relaxation inj vecuronium .08mg/kg iv or inj
rocuronium .6mg/kg iv
. Maintainence on O2 33% , N2O 66% and isoflurane upto 1%.
. Monitoring of vitals, urine output and blood loss.
EXTUBATION
.Reversal with inj atropine .02 mg/kg and neostigmine
.05mg/kg.

9. Anaesthesiology
NAUSEA AND VOMITING SCORE
0 – No nausea
1 – Mild nausea
2 – Moderate nausea
3 – Severe nausea
4 – Retching/ Vomiting
SEDATION SCORE
1 – Sleepy but not arousable
2 – Sleepy but arousable.
3 – Drowsy.
4 – Awake.

10. Anaesthesiology
VAS SCALE
0 3 5 7 10
0-3 Mild pain
4-7 Moderate pain
> 7 Severe pain
RESCUE ANTIEMETICS AND ANALGESIC
inj Ondansetron 4 mg iv
inj Diclofenac 1mg/kg im.

11. Anaesthesiology
OBSERVATION AND RESULTS
GROUP NO OF % OF
PATIENTS PATIENTS
MENSTRUAL 17 29
NON MENSTRUAL 43 71
TOTAL 60 100

12. Anaesthesiology
PIE DIAGRAM SHOWING
DISTRIBUTION OF
CASES IN BOTH THE
GROUPS
Menst
29% rual
Nonm
71%
enstru
al

13. Anaesthesiology
COMPARISION OF DEMOGRAPHIC PROFILE
PARTICULAR MENSTRUATION NON t p
MENSTRUATION VALUE VALUE
AGE 27.53 9.07 .026 >0.05
26.91 6.55
WEIGHT 50.76 8.79 52.91 12.34 .03 >0.05
DURATION 77.94 26.28 78.14 37.48 .02 >0.05
OF SURGERY
P value >0.05 is not statstically significant.

14. Anaesthesiology
NO STATISTICAL SIGNIFICANCE IN BOTH THE GROUPS
Demographic profile
Duration of surgery
Vital parameters.
OVERALL INCIDENCE OF PONV
MENSTRUAL PERIOD – 70.5%
NON MENSTRUAL PERIOD – 36%.
The incidence of PONV was increased in the
menstrual group at about 30min 90 min, 6hrs and
12 hrs but it was statstically significant at only
about 12hrs.
NO STATISTICAL SIGNIFICANCE IN BOTH THE GROUPS
Sedation score
VAS score

15. Anaesthesiology
COMPARISION OF NAUSEA VOMITING SCORE IN
STUDY GROUPS
TIME MENSTRUAL POST MENSTRUAL T P
Mean SD(n=17) Mean SD(n=43)
30 min 0.59 1.33 0.21 0.77 1.10 >0.05
60 min 0.94 1.25 0.53 1.12 1.17 >0.05
90 min 1.35 1.58 0.53 1.24 1.91 >0.05
120 min 0.71 1.36 0.30 0.83 1.14 >0.05
6 hrs 1.06 1.43 0.42 1.12 1.65 >0.05
12 hrs 1.18 1.70 0.09 0.37 2.60 <0.01
24 hrs 0.06 0.24 0 0 1 > 0.05

16. Anaesthesiology
•

17. Anaesthesiology
• DISCUSSION
• SECOND MOST COMMON COMPLAINT POST OP PATIENTS.
• DETERMINES THE LENGHTH OF HOSPITAL STAY.
• INFLUENCED BY MENSTRUAL CYCLE.
• HORMONAL INFLUENCES MOSTLY ESTROGENIC.
• HYPOTHESIS BY BETTIE et al, estrogen acts on
receptors other estrogen receptors to increase PONV.
• FSH AND OR ESTROGEN RATIO PLAYS AN
IMPORTANT ROLE.
• ADDED STIMULUS OF ANAESTHESIA AND
SURGERY.
• ESTROGEN INCREASES THE NUMBER AND
SENSITIVITY OF DOPAMINE RECEPTORS.

18. Anaesthesiology
NO STATISTICAL SIGNIFICANCE IN BOTH THE GROUPS
DEMOGRAPHIC PROFILE
PRE OPERATIVE PARAMETERS
POST OPERATIVE PARAMETERS
• IDENTICAL PREMEDICATION AND ANAESTHETIC
TECHNIQUE.
• INCIDENCE OF PONV
MENSTRUAL PHASE- 70%
NON MENSTRUAL PHASE- 36.17%
• THE INCIDENCE OF PONV WAS INCREASED
IN MENSTRUAL GROUP AT 30, 90 MIN,6HRS
AND 12 HRS BUT WAS HIGHLY SIGNIFICANT
AT 12 HRS.

19. Anaesthesiology
CONCLUSION
THE INCIDENCE AND SEVERITY OF PONV IS
DEFINITELY INFLUENCED BY PHASE OF
MENSTRUAL CYCLE.
SURGICAL PROCEDURES ESPECIALLY DAY CARE
SHOULD BE SCHEDULED DURING NON
MENSTRUAL PHASE OF MENSTRUAL CYCLE.
GOOD PRE-EMPTIVE ANTIEMETIC SHOULD BE
GIVEN FOR SURGICAL PROCEDURES WHEN
DONE DURING MENSTRUAL PHASE OF
MENSTRUAL CYCLE.

20. THANK YOU!