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Anaesthesiology > PONV > Flashcards

PONV Flashcards

1
Q

Nausea definition:

A

A feeling of sickness with theinclination to vomit

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2
Q

Retching:

A

Spasm of the respiratory muscles against the glottis

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3
Q

Vomiting:

A

Expulsion of gastric contents involuntarily and forecfully through the mouth and sometimes nose

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4
Q

PONV?

A

Nausea and vomiting and retching within the first 24 hours post-operatively

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5
Q

What are the complications of PONV?

A
  1. Dehydration, metabolic derangements
  2. oesophageal rupture/tear
  3. bleeding, haematoma, wound dehiscence, clot disruption
  4. tachycardia and hypertension
  5. prolonged stay- more costs
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6
Q

What are the 2 centres that causes vomiting?

A
  1. chemoreceptor trigger zone(CTZ)

2. Vomiting centre in the medulla

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7
Q

What are the 2 receptors that are found on chemoreceptor trigger zone?

A
  1. Dopamine 2 receptor

2. 5-HT Receptors(serotonin)

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8
Q

What is the receptor found on the vomiting centre in the medulla?

A

It is the muscarinic or ACh receptor

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9
Q

What are the 4 stimulus of nausea and vomiting?

A
  1. Pain, repulsive sight/smell, emotional factors
  2. Motion sickness
  3. Endogenous toxins/drugs
  4. Stomach contents/pharynx
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10
Q

In regards to motion sickness, where does the impulse come from? What receptors are found here?

A
  1. The vestibular nuclei in the pons

2. It has histamine(H1 receptors) and muscarinic receptors

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11
Q

Where does the impulse travel to after the vestibular nuceli?

A

To the chemoreceptor trigger zone and then to the vomiting centre zone

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12
Q

What is the risk of post-operative nausea and vomiting based on in adults?

A

Apfel

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13
Q

How is the Apfel risk of PONV classified?

A
  1. female
  2. non smoker
  3. previous PONV
  4. post-operative opiods
    - the risk for no risk factors is 10%, 1 risk factor 20%, 2 RF is 40%, 3 RF is 60% and 4 RF is 80%
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14
Q

What are the things we can do to reduce the risk of PONV in high risk patients?

A
  1. Give regional anaesthetic
  2. Adequate Hydration
  3. TIVA:propofol
  4. Decrease use of post-operative opoids: ketamine, etomidate, neostigmine, N2O
  5. Anxiolytics
  6. acupuncture P6
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15
Q

What are the 3 side effects of dopamine receptor antagonists? Droperidol

A
  1. sedation
  2. prolonged QT interval
  3. extra-pyramidal side effects
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16
Q

What are the side effects of anticholinergics?

A
  1. dry mouth
  2. tinnitus
    . sedation
    4.blurred vision
17
Q

Give an example of a steroid used in PONV

A

Dexamethasone

18
Q

What are the main side effects of antihistamines:

A
  1. Drowsiness
  2. sedation
  3. blurred vision
  4. dry mouth
19
Q

What would you give intra-op to patients that present with medium and high risk of PONV?

A
  1. dexamethasone and droperidol
20
Q

What are the side effects of abtiseronerguc/5HT drugs?

A

Brain and GIT upset

They are very expensive

Anaesthesiology (25 decks)

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