Aromatherapy for treatment of postoperative nausea and vomiting
POSTOPERATIVE NAUSEA AND VOMITING Risk Factors and Prevention Plan.
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Transcript of POSTOPERATIVE NAUSEA AND VOMITING Risk Factors and Prevention Plan.
![Page 1: POSTOPERATIVE NAUSEA AND VOMITING Risk Factors and Prevention Plan.](https://reader035.fdocuments.us/reader035/viewer/2022072015/56649ebb5503460f94bc3f96/html5/thumbnails/1.jpg)
POSTOPERATIVE NAUSEA AND VOMITINGRisk Factors and Prevention Plan
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Cost• Postoperative nausea and vomiting incidence 25-30%• Leads to poor patient satisfaction• Delayed discharge• Hospital admission• Aspiration• Disruption of suture lines
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Risk Factors• Female Gender• History of motion sickness or postoperative N/V• Pain• High levels of anxiety• Long surgical procedure• Type of surgery (intra-abdominal, gynecologic, laparoscopic, breast,
ENT, strabismus)
• Incidence of postoperative N/V• 0 risk factor -10%• 1 risk factor -20%• 2 risk factors -40%• 3 risk factors -60%• 4 risk factors -80%
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Prophylatic Agents• Dopamine receptor antagonists
• Promethazine • long duration of action, may delay recovery from anesthesia
• Droperidol • NNT 5-7• excellent for nausea prophylaxis• FDA black box for QTc prolongation
• Side effects: sedation, restlessness, hypotension, extrapyramidal
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Prophylatic Agents• Anticholinergic
• Scopolamine • transdermal offers long duration of action, often used with opioid
premedication
• Side effects: sedation, dry mouth, dizziness, restlessness
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Prophylatic Agents• 5 HT3 receptor antagonists
• Ondansetron, Dolasetron, Granisetron • NNT 5-6 • binds to chemoreceptor trigger zone and vagal afferents, specific• Effectiveness is similar for all three, difference is cost
• Side effects: headache, constipation, elevated liver enzyme
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Prophylatic Agents• NK-1 receptor antagonist
• Aprepitant• Better efficacy for vomiting vs ondansetron up to 72 hours• Long duration of action
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Prophylatic Agents• Corticosteroids
• Dexamethasone• Long duration of action• NNT for late postoperative N/V 4.3• NNT for early postoperative N/V 7.1
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Postoperative N/V Prevention Strategy
• 1-2 risk factors• 5HT3 antagonists• Dexamethasone• Scopolamine• Droperidol
• 2-4 risk factors• Droperidol + 5HT3 antagonist• Dexamethasone + 5HT3 antagonist• Droperidol + dexamethazone
• Greater than 4 risk factors• Combination antiemetics and IV anesthesia with propofol
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References• Habib, AS; Gan, TJ. What is the Best Strategy to Prevent
Postoperative Nausea and Vomiting? Evidence-Based Practice of Anesthesiology. Chapter 40
• Van Erdewyk, JM. Postoperative Nausea and Vomiting. Anesthesia Review. Chapter 233