Nausea from anesthesia is becoming a thing of the past for many patients, thanks to a medication called Emend. Many people are more worried about nausea after anesthesia than they are about the surgery itself, especially if they have suffered from it in the past. Though they may be highly motivated to have a cosmetic surgery procedure, the idea of feeling sick afterwards becomes a mental block that can’t be surmounted. This is more of a concern for longer operations such as a mommy makeover, which includes a tummy tuck and breast surgery.
Though the incidence of post–op nausea and vomiting (PONV) is decreasing thanks to improved anesthesia medicines and techniques, it hasn’t quite gotten to zero. Many factors contribute to it, including the length of the surgery, type of procedure being performed, female gender, history of motion sickness, and others. And it isn’t purely a question of comfort and quick recovery; episodes of PONV cause brief spikes in blood pressure that can lead to bleeding and other problems with the surgery itself. A trade-off with anti-nausea medications given with anesthesia is that they can make arousal from the anesthesia prolonged, and they have their own list of side-effects.
Emend (aprepitant) is a medication that works in a completely different way from other PONV treatments because it prevents nausea but doesn’t work if you already have it. It is marketed for chemotherapy patients but is finding use in surgery as well, for patients who are prone to nausea. We have been using it for several years now in patients who report a history of PONV or who have a constellation of predisposing risk factors, and it has been close to 100% effective. Our anesthetist, Mary Kay Livingston deserves some props here too for constantly refining her approach, but even with her bag of tricks, I think the use of Emend has been extremely successful.
Emend is taken in pill form about an hour before the surgery. A major issue is a cost; since only one pill is given per prescription, the per-pill cost is quite high (around US$55). Most people who have had PONV feel that it is well worth the cost though.