post op N/V Flashcards
RF for PONV
female, motion sickness,
previous PONV, non-smoker
what are some factors that affect PONV?
anesthesia techniques: inhalation agents, NO, high does of neostigmime (anticholestinerase) , opioids
what does neostigmine do?
reverse the affects of anesthesia
what are surgical RF for PONV?
type and longer duration
tx of PONV pre-op
BZD for anxiolysis
aprepitant, dexamethasone, pre-hydration
tx of PONV intra op
use of regional anesthetics, propofol, analgesia (non-opioid)
ketamine, NG tube, anti-emetic therapy
what are some types of post op tx of PONV
serotonin agonists, neurokinin inhibitors, steroids, antihistamines, benzo, butyrophenones, metoclopramide, scopalamine
serotonin agonists?
ondansetron, granistron
act at 5HT-3 receptor
ADR: HA, D, constipation, arrhythmia, serotonin syndrome
neurokinin inhibitor?
aprepitant, often used in GI surgery
- Admin. pre-anesthesia reduces N/V up to 48 hours post-surgery
- blocks substance P production
- ADR: dizzy, D, HA, weakness
steroids?
dexamethasone
- unclear MOA, possibly affect prostaglandins in brain
- Clinically: reduce NV, may improve mood
•Adverse events: Dizziness, Mood change
antihistamines?
first gen (dimenhydrinate, promethazine)
- Work at emesis center and CTZ to reduce vomiting
- ADR: Sedation, confusion, dry mouth, urinary retention
Butyrophenones?
droperidol
- Work at CTZ to block N/V and at the D2 receptor
- ADRs: big deal; Prolonged QT (black box warning), hypotension, tachycardia, extra-pyramidal sx
how does metoclopramide work?
increases LES tone and promotes gastric emptying
what else needs to be considered in a pt with post op N?
MI especially in high risk cardiac pts
b/c N is a sx
