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ANESTHESIA ALERT
ing system for patients undergoing anesthesia. Patients get 1 point for
each of the following risk factors: female, history of PONV or motion
sickness, non-smoker and post-operative use of opioids.
Risk increases as the total points increase: An individual with no
risk factors has a 10% chance of experiencing PONV, whereas a
female non-smoker who is likely to receive narcotics for pain control
after surgery (3 risk factors) has a 60% chance of experiencing PONV.
Our study's results reinforced the fact that men are not immune to
PONV, yet we often forget about the male patient with a history of
motion sickness. By applying the Apfel scoring system to all patients,
men and women alike are now identified if they're at increased risk.
To better communicate this risk to the entire team, the PONV history
was added to our anesthesia questionnaire and to our SBAR (situation, background, assessment, recommendation) tool used in relation
to all patient communication.
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Attack the problem
After screening and communicating the risk and recommendations to
the anesthesia provider, we use best practices that were determined
from the literature to prevent and combat PONV.
• Fluids. Research suggests dehydration is a precursor to PONV.
Surgical patients are NPO, and that puts them at increased risk. For
example, a 150-lb. patient who has been NPO for 10 hours is 1 liter
behind on fluids. Recognizing this fact, we now start our IVs and
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