Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Principles of Anes II > PONV > Flashcards

PONV Flashcards

1
Q

Risk Factors for Adults: Patient specific

Main 4?

A

Female
Non-smokers
History of PONV
History of motion sickness

-Delayed gastric emptying
-Preoperative anxiety

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

PONV = ___% of pt
Peaks at ____ hrs
Persist for ____hrs

Intractable vomit = ____%

A

Most common patient complaint

**Overall incidence: 20-30% up to 80%*

Intractable vomiting: 0.1%

Peaks 6 hrs postop
Persists 24-48 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Risk factors for Adults: Anesthesia/PACU

Surgical risk factors for PONV?
–> What meds?
–> Surgery?

A

-Volatiles
-Nitrous oxide
-*Intra/Postop opioids
-Neostigmine
-Preanesthetic medication (ketamine/etomidate)

-Gastric distention
-Longer duration of anesthesia
-Mandatory po fluids before discharge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What surgeries are high risk for PONV? (5)

A

High-risk surgery
1. Laparoscopy (belly)
2. Laparotomy  Ileius
3. Ear, nose, throat surgery (ENT)
4. Neurosurgery
5. Breast, strabismus, or plastic surgery

**Belly, ENT, girlies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

PEDATRICS PONV

What high risk surgeries (5)?

How does Peds N/V compare to adult?

A

-Increases with age until puberty
-Male = female
-Vomiting 2x more than adults

  1. Adenotonsillectomy (ENT  bleeding)
  2. Strabismus repair
  3. Hernia repair
  4. Orchiopexy (fix undescended testicle)
  5. Penile surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Some general causes for PONV?

A
  1. Hypotension
  2. Hypoxemia
  3. Elevated ICP
  4. Gastric bleeding
  5. Hypoglycemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Strategies to reduce PONV??

Sedation?
Induction?
Opioids? Alternatives?
Anes? Gas?
Avoid (2):
Nursing protocol?

A

Regional/ TIVA Prop > General Anes

Intraop
-Supplemental O2
-Adequate Hydration
-Propofol for induction and maintenance

-Avoid nitrous
-Minimize neostigmine

Minimize opioids
-Infiltrate surgical wound with LA
-Non-steroidals

-Minimize motion, early ambulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Nitrous ___%+ is associated with PONV

A

Nitrous 50% or 0.5 MAC or greater

Less than 50% ehh maybe ok

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Things to do instead of opioids?

A

Single dose of morphine associated with…PONV doesn’t matter the dose

TO DO: Regional nerve blocks, high dose acetaminophen, wound infiltration with LA, gabapentin, COX2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Reversal of NMBD

How does neostigme/anti-cholinergics cause N/V??

What does of neostigmine??
>__mg?

A

MINIMIZE NEOSTIGME

Anticholinesterases: muscarinic actions on GI

** Dose related (> 2.5mg of neostigmine) **

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Atropine effect on PONV?

A

´Atropine reduces PONV

-Give NMBD that aren’t reversed…. Bc the reversal of NMBD cause N/V like neostigme. Can use LMA or intubate with NMBD (depending on case)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Isopropyl alcohol?

Adequate pre-hydration? How much?

Chewing gum?
Ginger?
Carbohydrate loading?
Peppermint?

A

-Adequate pre-hydration= 10-30 ml/kg

-Isopropyl alcohol (aromatherapy) : 50% reduction in nausea

Chewing gum :D
´ Potential improvement in nausea; stimulates motility

Questionable:
´ Ginger = No significant reduction

Carbohydrate loading =Overall questionable

Peppermint aromatherapy : not effective

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Acupuncture/ Acupressure

Stimulates ____?
How does it work? (3)
Better at inhib N or V?

A

P 6 stimulation:
1.). Hypophyseal secretion of beta-endorphins
2.) Subsequent inhibition of CTZ
3. ) Decreases acid secretion

Better at inhibiting nausea than vomiting

Short, effective early

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Recepters that can cause N/V:
BBB?

(8)

A

Chemo receptor has NO BBB!

Receptors:
´ Dopamine
´ Serotonin
´ 5-HT3
´
´ Histamine
´ Muscarinic
´ Neurokinin-1?

-Opioid
-Cannabinoid?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Emetic Center located ____________.

Direct/indirect? via ____?

Incoming stimuli acts at:
1.)
2.)
3.)
4.) –> 2 areas, what CN

A

Located in lateral reticular formation of brainstem

Indirect via AFFERENT incoming stimuli input to:

(afferent input)
1. Pharynx
2. GI tract (lack of gastric emptying/ distention)
3. Mediastinum
4. Afferent nerves from higher brain centers
–>CTZ from area postrema
–>Vestibular portion of 8th CN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Predicting PONV: Apfel score

Risk: Surgeries?
Predictors:

´ 0 risk factors: %
´ 1 risk factor: %
´ 2 risk factors: %
´ 3 risk factors: %
´ 4 risk factors: %

A

RISK:
-General anesthesia
-High risk: breast, dental, ENT, lap BTL

Predictors:
-Female,
-hx of PONV
-Postop opioids
-Nonsmoker

´ 0 risk factors: 10%
´ 1 risk factor: 20%
´ 2 risk factors: 39% * prophylaxis indicated here at 2 factors
´ 3 risk factors: 60 %
´ 4 risk factors: 79%

17
Q

Issues from N/V

A
  1. Tension on suture lines –> Wound dehiscence
  2. Aspiration
  3. Dehydration and electrolyte imbalance
  4. Increased intracranial and intraocular pressure
  5. Prolonged PACU
  6. Unanticipated admissions
  7. Increased cost of care
  8. Increased use of personnel and resources
18
Q

What is the gold standards?

A

***No single drug is gold standard

´ *Patients should not receive the same drug for prophylaxis and treatment

***Work on identifying and preventing as treating is +/- effective

19
Q

Anti-dopaminergics

S/E??
Works as: (3)

Subtypes:
1. Butyrophenones
2. Phenothiazines

A

Dopamine receptor antagonists are

1.) Anti-emetic
2.) Antipsychotic
3.) Neuroleptic

Can cause neuro s/e: drowsiness, sedation, EPS effects

20
Q

Anti-dopaminergics

  1. Butyrophenones SUBTYPE “-ridol”

Example 1: Haloperidol
Route?
PONV?

Example 2: Droperiodl
Dose?
Effective as _____.
More effective with ____
S/E: <3

BLACK BOX (2):
1.)
2.)

A

Haloperidol
- Not really approved for PONV
-Not approved for IV use, giving IM slows onset…

Droperidol
-never > 0.625 mg!
-As effective as Ondansetron 4mg
-With metoclopramide 10mg more effective

´ Weak alpha blocker…hypotension

Black box (BAD):
1. torsades de pointes (polymorphic v-tach)
2. sudden death

21
Q

Anti-dopaminergics
2. Phenothiazines
“-azine”

Prochlorperazine
Chlorpromazine

Promethazine (Phenergan)
-Dose:
-Antagonizes what receptors? (4)
-S/E???
-BLACK BOX: (2)

A

Promethazine (Phenergan)
´ 12.5-25 mg

Also antagonize:
1. Dopaminergic
2. Alpha adrenergic
3. Histamine
4. Muscarinic cholinergic receptors

Sedation, hypotension, EPS

Black box (BAD)
-tissue damage;
-respiratory arrest < 2 y/0

22
Q

Anticholinergics:
Scopalamine

PATCH DOSE:
LEAVE ON FOR: ____hrs

Works by:
S/E: !!

A

1.5 mg transdermal patch

´ leave in place 48-72 hours (2-3 days)

–>Blocks acetylcholine

–>Causes drowsiness, dry mouth, dizziness

place where there is thin skin

23
Q

5HT3 antagonists

-Dolasetron (Anzemet)
-Granisetron (Kytril)
-Palonosetron

Ondansetron (Zofran)
Dose??
WHEN TO GIVE???

A

4mg within 15-20 of surgery end

(want it to last when pt are awake!!)

´data unclear on 4mg vs. 8m

24
Q

Steroids:
Dexamethasone

USES:
1.)
2.)

S/E?

Dose??

WHEN TO GIVE???

A

1.) Decrease postop pain and edema
2.) Anti-inflammatory reaction
Not useful for rescue

´No adverse side effects
´Hyperglycemia

´Dose: 4mg as effective as 8mg (airway swell give more)

Given during/just after induction

25
Q

Gastrokinetics:

Metoclopromide (Reglan)

Function:
1.)
2.)

How effective??
S/E?
Dose?
1/2 life?

WHEN TO GIVE??

A

1.) Increases LES tone
2.) ^GI motility

´ Less efficacious than droperidol (dopamine antag)
´½ of studies indistinguishable from saline <->

Restlessness, EPS NOT Good for elder, prob just for DM pt

´ Dose: 10-20mg IV
´ Short ½ life…dosing?

26
Q

NK-1 antagonists:
Aprepitant

Works by:
1.
2.
3.

Dose:

Better nausea or vomit?

WHEN TO GIVE??

A

1.) Antagonize Substance P in the emetic center
2.) Depress neural activity of the nucleus tractus solitarius
3.) May also interfere with afferent messages from enterochromaffin cells

Dose 40mg or 125 mg

Greater anti-vomiting than anti-nausea

Given 2-3 hours prior to induction

27
Q

Propofol

Works by:

Dose?

Brady? Give _____.

A

–>Blocks serotonin release at 5HT3 receptors

–>
´In subhypnotic doses
´ May also inhibit CTR

Dose 16.7 mcg/kg/min (subhypnotic) or full TIVA dose

28
Q

WHEN TO GIVE:

Zofran:

Dexamethasone:

Metoclopromide (Reglan)

Aprepitant

Propofol

A

Ondansetron (Zofran): 15-20 of surgery end

Dexamethasone
Given during/just after induction

Metoclopromide (Reglan)
Short ½ life give before waking up??? Check in lec

Aprepitant
´Given 2-3 hours prior to induction

Propofol
-Induction, maintainence, and subhynoptic dose

29
Q

WHEN TO GIVE:

Zofran:

Dexamethasone:

Metoclopromide (Reglan)

Aprepitant

Propofol

A

Ondansetron (Zofran): 15-20 of surgery end

Dexamethasone
Given during/just after induction

Metoclopromide (Reglan)
Short ½ life give before waking up??? Check in lec

Aprepitant
´Given 2-3 hours prior to induction

Propofol
-Induction, maintainence, and subhynoptic dose

Principles of Anes II (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions