Outpatient Surgery Magazine

Manager's Guide to Surgery's Ambulatory Anesthesia - July 2015

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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Page 58 of 68

J U LY 2 0 1 5 O U T P A T I E N TS U R G E R Y. N E T 5 9 a method established for collecting and measuring it. So we asked how often any type of antiemetic medication was administered in PACU. While we're aware that some providers go the antiemetic route before they deliver post-op pain meds, we wanted an estimate of PONV prevalence for baseline purposes. Our query of 1,010 adult PACU admissions revealed 542 antiemetic administrations for a PONV incidence rate of 53.7%. The next question: Could we proactively lower the incidence rate with an alternative to routine PACU care? Our search for an evidence-based solution began with an in-depth review of the available medical literature on the compli- cation. We found 2 themes repeating throughout the studies. First, the use of a pre-operative PONV risk screening tool is effective. Second, you should target antiemetic prophylaxis based on risk stratification (see "Who's Most at Risk?"). There is no shortage of options in your antiemetic arsenal. Some of the most common prophylactic options include the following: • total intravenous technique (TIVA) • a peripheral nerve block • scopolamine patch, 1.5 mg • metoclopramide 10 mg IV • ondansetron, 4 to 8 mg IV • haloperidol, 1 mg IM or IV • dexamethasone, 4 mg IV • ephedrine 0.5 mg/kg IM • diphenhydramine, 25 to 50 mg IV or IM • hydration, 25 ml/kg IV At our center, patients classified as low risk are administered at least 1 antiemetic intervention. Moderate-risk patients receive at least 2 interventions, and high-risk patients get at least 3. Our approach differed slightly from that described in SAMBA's updated guidelines, in that we chose to treat low-risk patients as well as the moderate- and high-risk ones. Our efforts to improve our preventative protocols focused only on adult patients, but SAMBA's revised guidelines offer addi- tional insights into PONV screening and prophylaxis for pediatric patients, for whom the length of surgery is a significant risk factor and the formulary of antiemetic drugs differs from the adult options. — Christopher A. Smith, CRNA, DNP Chester Wei, CRNA

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