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P O S T- O P
M A N A G E M E N T
READ AND REACT
When Patients Feel Nauseous
what's been administered. Adequate hydration
can also be assessed by urine color and quanti-
M
ost anesthesia providers will claim
ty. Other clues may be garnered from the pulse
track records of PONV incidence
oximeter's waveform or, if available, the arterial
rates lower than the commonly
line trace showing respiratory variation. If the
quoted 30% of patients. Realistically, though,
patient is dehydrated, administer a fluid bolus
after patients leave their immediate care, very
through the in situ IV and they should start to
few issues come to their attention, unless it's
feel better.
an extremely serious situation. Sore throats
• Ask patients to rate their post-op pain on a
and even PONV are often chalked up to the
numerical scale and evaluate their blood pres-
well-known and acceptable risks of anesthe-
sure, heart rate and respiration (which, when
sia. Not hearing about yesterday's or last
increased, suggest incomplete pain manage-
week's cases implies that you did a good job,
ment) to help you appropriately treat what's ail-
and that the surgeon and patient were satisfied ing them.
• Oxygenation is the easiest to assess. A
with the outcome.
But what if your providers are summoned
pulse oximeter number in the high 90s is very
reassuring (100 is the maximum). Dipping into
back to PACU for patient complaints of
the low 90s or high 80s should raise immediate
nausea and the urge to vomit? First and
concern.
foremost, they should hold off on
If none of these 3 factors prove con-
administering drugs right away.
cerning on examination, however,
The right way for providers to
prescribe an antiemetic from a
deal with the situation is to
class you haven't yet adminis-
evaluate the patient, considering the following
tered: droperidol, for instance,
potential issues.
or even Benadryl. Alternatively,
• Dehydration causes nausea and
less conventional but sometimes
can be easily rectified with appropri-
effective remedies include acu-
ate hydration. Providers should be
able to calculate a patient's fluid balance, their need (deficit) versus
4 6
UNEASY FEELING
Event the best PONV prevention practices can't
ensure patients won't feel
sick.
SUPPLEMENT
TO
pressure, electro-acupressure,
aromatherapy or ginger.
— Ashish C. Sinha, MD, PhD
O U T PAT I E N T S U R G E R Y M A G A Z I N E | J U LY 2013
