may result in 10, 12 or 14 hours without eating before surgery, actually increases
PONV risk. It's safe to encourage otherwise healthy patients to drink clear fluids
up until 2 hours before surgery. Keep them hydrated by starting an IV in pre-op.
Finally, right before surgery, I like to give susceptible patients anxiety-dampen-
ing medications, not just to calm them down, but also because benzodi-
azepenes, like midazolam, may have antiemetic properties.
4
Avoid opioids
Of course, the real dark villains of the PONV drama are narcotics and
their evil sidekicks, volatile inhaled anesthetics. Having determined that
you're working with a vulnerable patient, can you get her through surgery and
out the door without using narcotics or inhalation agents? At the very least, you
want to minimize your use of agents that are known to promote PONV.
P O N V
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