PONV Flashcards
Incidence of PONV
10-30%, average is 30%
what surgery has high incidence
peds opthalmic surgery 11 of 150 with treatment cataract 16% strabismus 8.3% glaucoma 4.9%
factors influencing PONV: post op factors
pain, dizziness, early first movement after surgery, early first oral intake, opioids
factors influencing PONV: surgical factors
gynecological, abdominal, ENT, opthalmic, craniotomy, plastic surgery
factors influencing PONV: anesthetic factors
premedications, anesthetic agents, gastric distention, duration and depth of anesthesia
factors influencing PONV: patients at risk
age (<50), gender (female), obesity, hx of PONV or motion sickness, anxiety, gastroparesis
possible impact of PONV
patient discomfort (mild to severe) interruption of oral intake wound dehiscence electrolyte imbalance and dehydration aspiration of vomitus
classification of standard antiemetic agents
phenothiazines- chloropromazine, chloro[romethazine Butyrophenones- droperidol, haloperidol Benzamines- metaclopromide Anticholinergics- scopolamine Antihistamines- hydroxine
side effects of phenothiazines
sedation, hypotension, extraparymidal effects, dry mouth, urinary retention, tachycardia
side effects of butyrophenones
sedation, dystonic reactions, hypotension, tachycardia, extrapyramidal reactions, anxiety, restlessness, arrhythmias
side effects of benzamides
drowsiness, restlessness, fatigue, anxiety, extrapyramidal reactions
side effects of anticholinergics
sedation, dry mouth, visual distrubances, memory loss, confusion, hallucinations
side effects of Antihistamines
sedation, blurred vision, dry mouth, urinary retention, tachycardia
side effects of 5HT3 receptor antagonist
headache, dizziness, mild drowsiness, constipation, arrhythmias (rare)
5-HT3 receptor selectivity
serotonergic receptors of the 5-HT3 subtype seem to have a crucial role in the systems mediating emesis
Ondansetron has a greater affinity for this receptor than any other
Avoids the acute dystonic reactions associated with dopamine blockade
