factors — young female, GYN procedure, non-smoker, general anesthet-
ic — to wear a scopolamine transdermal patch the night before surgery
(and warn her of the dry mouth and dizzy side effects). Soon after
induction, I'd add 4-8 mg of Decadron and 6.25-2.5 mg of Benadryl (by
giving Benadryl up front, the antiemetic property should outlast the
sedative effect). At the end of the procedure, I'd give Zofran
(ondansetron), which takes 30 to 60 minutes to reach peak effect and
should coincide with the PACU arrival time.
5. Let go of NPO. It might be time to revisit the "no drinks after
midnight" standard. Some patients can have clear liquids 2 hours before
surgery, including carbohydrate-loaded drinks. They won't be as dehy-
drated and nauseated after surgery. The less time the patient is NPO,
the better. If you can get patients awake, and taking food and drink as
soon as possible so they can take pain medications by mouth, you'll
bridge their pain from their anesthetic to their discharge.
6. Enlist your surgeons. Ask the surgeon who's chronically late
signing patients out if he would promptly write discharge instructions
(and prescriptions, too!). It might be tough to get surgeons off of their
own timelines, so enlist a well-liked doc to practice prompt paper-
work in the hope that others will follow.
Long road home
When you wheel a patient through the recovery room doors for the
final leg of her surgical journey, it should be nothing but green lights
and open highways, all roads leading to the parking lot and the pain-
free, nausea-free ride home.
OSM
5 8 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • J U L Y 2 0 1 8
