More attention should be paid to PONV and patient satisfaction in the postoperative period

Nowadays we all seem to focus our attention on quality assurance - in operating room management, therapy of patients, in research, etc. Audits are regularly performed with the aim of improving safety. Quality assurance of our work in the eyes of the patient is often neglected. Studies, particularly those from Canada, have shown that patients often complain: they are not satisfied. If patients experience postoperative pain they will not appreciate anything that is done for them - lodging, food, etc. Provision of optimal pain therapy is therefore of prime importance. Fifteen to twenty per cent of patients (predominantly women) experience postoperative nausea and vomiting (PONV) after general anaesthesia. This is mostly a side-effect from the use of opioids needed to curb pain. Patients receiving patient-controlled anaesthesia (PCA) sometimes refrain from the use of self-administered morphine in order to prevent PONV occurring and rather prefer to be in moderate pain. PONV must therefore be aggressively treated preferably prophylactically. One other major cause of patient dissatisfaction is a sore throat following endotracheal intubations which may occur in up to 40% of patients. It is important to perform intubation as non-traumatically as possible and to pay attention to an eventual increase in cuff pressure especially when using N2O as a component of the anaesthetic. We must also learn to look for signs of anxiety in our patients and use premedicant drugs appropriately. In one study, patients judged to be calm and relaxed by the anaesthetist before the induction of anaesthesia were in fact terrified of the forthcoming anaesthesia and operation. It is important that we pay more attention to the needs of our patients. Safety comes first but patient comfort should not be neglected.