Antiemetics

Question 1

what is “PONV”?

Answer 1

“Post-operative Nausea & vomiting”

• refers to feeling nauseated following a surgical procedure during which anesthesia was administered.

** It does not necessarily imply the act of “vomiting” occurred.

Question 2

T/F: PONV is the most common post-op complaint following sedation

Answer 2

FALSE

pain = #1
PONV = #2

Question 3

The vomiting center lies in the ______

Answer 3

medulla

Question 4

what are the 4 ways the vomiting center can be activated?

Answer 4

1) GI tract
2) cerebral cortex/ thalamus
3) vestibular region
4) chemoreceptor trigger zone.

Question 5

what are the substances/compounds that can trigger nausea and vomiting?

Answer 5

1) general anesthetics
2) histamine
3) serotonin
4) dopamine
5) OPOIDS
6) acetylcholine
7) inflammatory mediators (neurokinin, substance P)

Question 6

what population groups are at the highest risk for N&V?

Answer 6

1) females
2) non-smokers
3) history of motion sickness

Question 7

what are the only TWO anesthetics that appear to INCREASE the threshold for PONV?

Answer 7

propofol and midazolam

Question 8

T/F: In general, antiemetics act as receptor antagonists at the receptors located in the vomiting center (and its associated areas).

Answer 8

true

Question 9

For IV sedation, The most frequently used antiemetic agents that we administer at OSU are ______________ and ____________

Answer 9

Ondansetron (Zoran)

Dexamethasone (Decadron).

Question 10

how do we administer IV Dexamethasone?

Answer 10

4mg IV in adults

0.1mg/kg in those patients under 40 kg

** give dose slowly!!! **

Question 11

how do we administer IV Ondansetron?

Answer 11

4mg IV in adults

0.1mg/kg in those patients under 40 kg

Question 12

T/F: a second dose of Dexamethasone can be administered as a “rescue dose” to patients complaining of post-op PONV

Answer 12

FALSE

Dexamethasone is for Prophylactic management

we give Ondansetron as a rescue dose

Question 13

what is the typical dosing for Scopolamine? (for antiemetic)

Answer 13

A) delivered as patch behind the ear

B) delivers 1mg Scopolamine per day, for 3 days

Question 14

what is the typical dosing for Promethazine? (for antiemetic)

Answer 14

6.25 mg IV per dose.

Can repeat to up to 4 doses

Question 15

what is the “Trendelenberg” position? when is it used?

Answer 15

recline the patient (head below chest) to reduce aspiration risk

Question 16

if a patient starts to vomit, you want to roll them onto their _____ side

Answer 16

RIGHT side

• right lung branches above the left, so you sacrifice that lung to protect the left

Question 17

T/F: you should always Auscultate a patient that has vomited

Answer 17

TRUE