2 8 • S U P P L E M E N T
T O O U T P A T I E N T S U R G E R Y M A G A Z I N E • M A R C H 2 0 2 1
I developed the following protocol to treat
PONV preemptively. It's worked well for
me, so I'm passing along the specifics if
you want to give it a try at your facility.
• Begin with the basics. Standard
intraoperative antiemetic prophylaxis
(barring contraindications) consists of
dexamethasone (Decadron) 10mg IV at
induction followed by diphenhydramine
(Benadryl) 25mg IV. I do this prior to the
incision so each of these medications can
work on their respective areas before the
patent experiences the physiologic
response of surgical stimulation. I also
chose dexamethasone because of its
anti-inflammatory properties, particularly
for the airway. Because a sizable portion
of my cases involve breathing tubes, I
want to cut back on issues with airway
swelling from manipulation of the tra-
cheal structures during laryngoscopy.
• Apply the patch. Patients with known
risk factors or history of PONV receive a
scopolamine patch placed behind their
ear before surgery. One center that I
work for will prescribe this patch in
advance of the case, so the patient can apply it
before arrival. The other center has them avail-
able on an as-needed basis.
The patch is extremely helpful with high-risk
PONV patients, because it can be applied prior to
surgery and kept on for three days. If treatment
is needed for longer than three days to help pre-
vent nausea and vomiting, patients can simply
remove the current patch and apply a new patch
behind the other ear.
• Rescue in recovery. In the PACU, patients
who experience PONV receive ondansetron
(Zofran) 4mg IV. I only use this as a rescue drug,
because it works differently than my intraopera-
tive medications. Since implementing this
protocol, I've received only one call from a PACU
nurse requesting a one-time administration of
ondansetron. That patient underwent bilateral
mastectomy under general anesthesia.
Another effective option in a preemptive
approach to PONV prevention is aromatherapy.
I've had some experience using it as a bedside
nurse, and it has helped decrease post-op nau-
sea. Nurses can place an alcohol swab under
the nose of a recovering patient who's nauseous
in a pinch, but the aromatherapy inhalers offer a
blend of four pure and natural essential oils —
lavender, peppermint, ginger and spearmint —
that can have therapeutic effects on nausea.
— Ryan Wade, CRNA
SKIN TREATMENT Placing a scopolamine patch behind a patient's ear before surgery can help
prevent nausea and vomiting.
RECIPE FOR RELIEF
A Proactive Approach to PONV Prevention
