the case, both for its antiemetic properties and to help with post-op
pain control.
The 5 surgeons at the (Savannah) Georgia Institute for Plastic
Surgery have "zero tolerance for post-operative nausea and vomiting,"
says Janice Izlar, CRNA. To prevent it, she pulls out all the stops, start-
ing with 8 mg of ondansetron as soon as patients arrive. All patients
having facial procedures also get 8 mg of dexamethasone, unless con-
traindicated, and those with a history of PONV or motion sickness get
10 mg IV of diphenhydramine during the case. Metoclopramide (5 mg)
may also be part of the recipe if patients have a history of GERD or
heartburn issues.
Andrew Schulman, a CRNA at Morpheus Anesthesia Services in
Cape Girardeau, Mo., starts with ondansetron for almost every
patient, but in the presence of certain risk factors, augments with dex-
amethasone and scopolamine — completing the so-called triple thera-
py that's been shown effective in a wide variety of patients.
The third leg of the tripod for CRNA Robert Shearer of UltraCare
Anesthesia Partners in Vineland, N.J. — along with ondansetron and
dexamethasone — is Quease Ease, an aromatic inhaler that relieves
nausea, but it's not always easy to come by, he says: "I'd use it more if
my centers supplied it. I keep asking for them to."
And never lose sight of the basics, says Mr. Donovan: "The absolute
best antiemetic drug of choice is IV fluids," he says. "Proper rehydra-
tion after being NPO may be the single most important intervention
we can do as anesthesia providers."
2. Video laryngoscopes
The once lonely voices who viewed video laryngoscopes as must-
haves have been joined by a chorus of supporters.
"Studies have shown that video laryngoscopy improves endotra-
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