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P O S T- O P
M A N A G E M E N T
tube out of the back of their throat.
bonus, the nursing crew will have a
We roll them from the table onto a
patient who is less likely to suffer
stretcher and push them to the recov-
PONV.
ery room on their backs, making a few
twists and turns and bumping up
Discharge directives
against a few doors and walls along
Standard discharge orders generally
the way. As the disoriented patients
include requirements to "ambulate
arrive in PACU, nurses roll them to
before discharge" and "tolerate p.o."
examine, transfer and position them
But forcing patients to tolerate a clear
in the post-op bed. That's an obstacle
soft drink and crackers on an empty
course of vomit-inducing stimuli.
stomach so soon after anesthesia can
The nausea they may be suffering
be cruel and unusual punishment,
immediately after the OR can be treat-
especially if they're at high risk for
ed with a small dose of propofol.
PONV. People don't forget how to eat,
Here's how. If you add 2cc or 3cc of
just because they've been anes-
lidocaine to your propofol, it'll keep
thetized. Why not see if they'll tolerate
you from drawing the entire vial of
a few ice chips, then discharge them
sedative into a 20cc syringe. The last
with the recommendation that they
2cc or 3cc of propofol usually gets
sip a small to moderate amount of
tossed. But if you draw up the remain-
clear broth, slowly, when they feel
der in a sterile manner, and the case
hungry at home? They can follow this
lasts less than 3 hours, you can give
with slowly easing into their normal
patients the leftover propofol once
diet.
they've arrived in PACU to attenuate
Lastly, ambulation in a patient who
the vomiting reflex. While the patient
hasn't fully recovered from anesthe-
takes a short nap, give your report to
sia can set off the nausea-and-vomit-
the PACU nurse. Five minutes later, by
ing cycle, so any walking should be
the time you're ready to return to the
done very slowly and carefully. Make
OR, the patient will be responsive,
sure the patient's escort knows not
awake and comfortable. As an added
to drive like an Andretti on the way
J U LY 2013 | S U P P L E M E N T
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O U T PAT I E N T S U R G E R Y M A G A Z I N E
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