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P O S T- O P
M A N A G E M E N T
Either of them is an effective adjunct
drugs that affect the same receptor
to the 5HT3 antagonist ondansetron
group does nothing in terms of addi-
(Zofran). Keep in mind that while
tional protection. But a combination
scopolamine lasts for 24 hours, it
that includes a 5HT3 antagonist, a
takes 4 hours to start working.
steroid (almost always safe) and a
Don't underestimate the power of
scopolamine patch (if there's no con-
the mind. When my patients are drift-
traindication) is my favorite triple-
ing off to anesthetic sleep, I tell them,
cocktail for patients most at risk.
"You will wake up warm, comfortable
Additional drugs that may be effective
and hungry." I've not subjected this
include droperidol and metoclo-
practice to a randomized, prospective,
pramide.
placebo-controlled clinical trial, but
Avoid nitrous oxide. For nearly a
anecdotally it seems to work. New OR
decade we've known that nitrous
personnel sometimes ask me, "Why
oxide (as opposed to air) causes 12%
did you say 'hungry?'" It's simple: In
more PONV. Think about that: If
most cases, when you're hungry,
you're using nitrous, every eighth
you're not going to be nauseous.
patient who wouldn't have hurled if
you were giving them air, will with
Intraoperative insights
nitrous oxide. Perhaps total intra-
Pay close attention to the details of
venous anesthesia (TIVA) is the
fluid administration, pain control and
answer. Propofol has antiemetic prop-
oxygenation. For those deemed high
erties, which is a large part of the rea-
risk, a multimodal prophylaxis is
son it's so popular for use as an ambu-
advisable and often helpful.
latory anesthetic.
A multimodal approach to PONV
Use the least amount of opioids
prophylaxis uses drugs from different
possible. Non-narcotic anesthesia
classes to help block different recep-
techniques are showing promise in
tor subtypes in the chemoreceptor
many patient classes. Initially driven
trigger zone, which is what stimulates
by the need to avoid respiratory
the emetic center. Giving multiple
depression and its potentially deadly
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