Antiemetics/Aspiration Prophylaxis Flashcards
PONV definition
nausea or vomiting within 24 hrs of surgery
2 leading causes of unanticipated hospital admission after outpatient surgery
pain & PONV
what % of patients without prophylaxis have nausea after general anesthesia
40%
what % of high-risk patients have PONV without prophylaxis
80%
risk factors for PONV
female= strongest indicator
nonsmoker
hx of PONV and/or motion sickness
surgical factors for PONV
longer procedures
certain procedures (GYN, laparoscopy, ENT, breast/plastics)
anesthetic factors for PONV
inhalational agents
nitrous
neostigmine
opioids
what is the greatest association of PONV for children
surgical procedure
hernia, tonsila, male genitalia
when does adult PONV risk decrease
may ↓ with age
PONV is associated with
dehydration, electrolyte abnormalities, wound dehiscence, bleeding, airway compromise and UNPLANNED ADMISSIONS and PATIENT DISCOMFORT
scopolamine can prevent
motion-induced nausea and PONV
motion sickness is caused by
stimulation of the vestibular apparatus
what can increase vestibular sensitivity to motion
opioids and morphine
transdermal absorption of scopolamine is beneficial because
patients may have less sedation, cycloplegia, and drying of secretions
zofran mechanism of action
Selective 5-HT3 receptor antagonist in GI tract and Chemoreceptor Trigger Zone
zofran uses
preventative and rescue treatment for N/V
used in chemo
zofran side effects
headaches
diarrhea
zofran should be used carefully in
patients with prolonged QT interval → can lead to torsades
zofran questionable use
obstetrics
zofran dose
4mg IV
zofran duration
4-6 hours
zofran metabolism
extensive hepatic metabolism
Dexamethasone uses
N&V prevention
ENT
traumatic intubations
Dexamethasone mechanism of action
Mechanism is unclear, proposed to centrally inhibit prostaglandin synthesis and control endorphin release