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Hydrate and reduce anxiety
Above all, make sure patients are hydrated. The best way to do that?
Don't let them become dehydrated to begin with. We've learned over the
years that the old saw about having nothing to eat or drink after midnight, which
P O N V
The science related to understanding and
preventing PONV is both very interesting
and very important, and I expect some
new approaches to be coming down the
pike shortly.
For instance, when I was in training,
droperidol was considered the be-all and
end-all for treating PONV. But the FDA
issued a "black box warning" in 2001, because it was linked to a certain rare heart
condition. It's rarely used anymore. Worth noting, however: Pharmaceutical com-
panies are working on making a droperidol analog that doesn't contain the cardiac
risk factor, so we may see that on the market soon.
Another company is working on developing a pill or a patch that uses the
antiemetic properties of propofol, but alters its molecular structure so it no longer
acts as an anesthetic.
And now there's a second generation of the popular antiemetic drug
ondansetron (Zofran) called palonosetron, which has fairly recently hit the market,
and which shows promise as a PONV-prevention therapy.
Meanwhile, scientists are trying to determine whether some people have a
genetic predisposition to nausea after surgery. If they can identify key genetic vari-
ations in the way people metabolize drugs or react to stressors, we should be able
to do an even better job of tailoring treatments for those people.
— Steven Gayer, MD
BRIGHT FUTURE
Better PONV Treatments on the Way?
ALL SMILES Patients might be happier in
post-op in the near future.
Jason
Meehan
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