Morgan & Mikhail Chap 17(Adjuncts to Anesthesia) Flashcards
Properties of commonly used H1-receptor antagonists
Pharmacology of aspiration pneumonia prophylaxis
METOCLOPRAMIDE
By enhancing the stimulatory effects of acetylcholine on intestinal smooth muscle,
metoclopramide increases lower esophageal sphincter tone, speeds gastric emptying,
and lowers gastric fluid volume
Postoperative Nausea & Vomiting
Without any prophylaxis, postoperative nausea and vomiting (PONV) occurs in
approximately 30% or more of the general surgical population and up to 70% to 80% in
patients with predisposing risk factors. The Society for Ambulatory Anesthesia
(SAMBA) provides extensive guidelines for the management of PONV. Table 17–3
identifies risks factors for PONV and scores the evidence for assessing risk. When
PONV risk is sufficiently great, prophylactic antiemetic medications are administered,
and strategies to reduce its incidence are initiated. Risk reduction strategies include:
- Avoidance of general anesthesia by the use of regional anesthesia
- Use of propofol for the induction and maintenance of anesthesia
- Avoidance of nitrous oxide in surgeries lasting over 1 hour
- Avoidance of volatile anesthetics
- Minimization of intraoperative and postoperative opioids
- Adequate hydration
- Use of sugammadex instead of neostigmine for the reversal of neuromuscular
blockade
Adult PONV
Peds PONV
5-HT3 RECEPTOR ANTAGONISTS
Ondansetron, granisetron, tropisetron, ramosetron, palonosetron, and dolasetron
selectively block serotonin 5-HT3 receptors, with little or no effect on dopamine receptors. 5-HT3 receptors, which are located peripherally (abdominal vagal afferents) and centrally (chemoreceptor trigger zone of the area postrema and the nucleus tractus solitarius), appear to play an important role in the initiation of the vomiting reflex.
Neurological pathways involved in the pathogenesis of nausea and vomiting
KETOROLAC
Ketorolac is a parenteral nonsteroidal anti-inflammatory drug (NSAID) that provides analgesia by inhibiting prostaglandin synthesis. A peripherally acting drug, it
has become a popular alternative to opioids for postoperative analgesia because of its minimal central nervous system side effects.
Others (Look at on PPs or Other Chapters)
Acetaminophen
CLONIDINE
DEXMEDETOMIDINE
GABAPENTIN & PREGABALIN
CAPSAICIN
DOXAPRAM
NALOXONE
NALTREXONE
FLUMAZENIL
