(2-08-17) Antimetics Flashcards
the subjective feeling of need to vomit
naseau
emesis, the oral expulsion of GI contents
vomiting
also known as retching, the muscular event of vomiting wo expulsion of GI contents
dry heaving
what does PONV (post-operative naseau and vomitting) refer to
the FEELING of being nauseated following a surgical procedure during which anesthesia was administered. It DOES NOT necessarily imply the act of “vomitting” occured
what are the two most common post-operative complaints?
- Pain
2. PONV
where do the vomitting centers lie?
in the medulla
what activates vomitting centers?
emetogenic mediators
-activate either directly or indirectly, leading to motor activation of the GI tract, abdominal muscles, and diaphram causing “upward” contractions of the GI tract
the vomitting center can be INDIRECTLY activated by receiving inputs from 1 of 4 areas. what are they?
- GI tract
- cerebral cortex/ thalamus
- vestibular region
- chemoreceptor trigger zone
what is the GA exception to causing NV?
propofol
-and midazolam
- these both INC the threshold for PONV
- affect may be related to anxiolysis
what are the main risk factors for pt to experience NV?
- female
- nonsmoker
- hx of motion sickness
- hx of PONV
- level of anxiety prior to surgery
- type of surgery
how to antimetics work?
act as receptor antagonists at the receptors located in the vomitting center of the brain
what are the most commonly used classes of antimetic drugs?
- serotonin antagonists
- dopamine antagonists
- anticholinergics
- glucocorticoids
- histamine antagonists
- neurokinin 1 antagonists
for IV sedation, what are the most commonly used agents we use at OSU
Ondansetron (Zofran)
dexamethasone (decadron)
what are other IV sedation drugs used less frequently
scopolamine patch
promethazine
to manage the overly sedated/ vomitting patient, what are some recommendations from the literature?
- “trendelenberg” position (recline pt, head below chest)
- turn to the RIGHT (sacrifice right lung to save the left)
- administer supplemental oxygen
- transport to emergency department if you suspect aspiration
