post-op nausea and vomiting - PACU Flashcards
Acute postoperative nausea and vomiting definition
Any episode of nausea or vomiting that occurs within 24 hours after receiving an anaesthetic.
Nausea definition
A subjective and unpleasant sensation associated with the conscious awareness of the urge to vomit
Retching definition
Rhythmic and spasmodic contractions of the respiratory muscles, diaphragm, chest wall and abdominal muscles, without the expulsion of gastric content.
Vomiting or emesis definition
Forceful expulsion of gastric content from the mouth and is brought about by coordinated motor changes involving muscles of the respiratory and GI systems.
Risk factors for PONV
- age
- women
- obesity
- hx of PONV
- smoking
- alcohol
- migraines
When is PONV induced
- pain and movement
- anxiety
- hypotension
- hypoxaemia
- hypoventilation
- hypovolemia
PONV complications
- corneal damage
- aspiration of vomit into the lungs
- damage to operative site, requiring dx change, predisposing it to infection
- dehydration
- pain from stress to surgical site
- increased ICP
- tear and rupture oesophagus
- aspiration can lead to pneumonia
PONV management
Prevention is more effective than initiating therapy after the onset of symptoms.
- assess for risk factors
- Apfel score for inpt undergoing surgery
PONV risk mitigation
- Minimise use of nitrous oxide, volatile anaesthetics, high-dose neostigmine
- Consider regional anaesthesia
- Opioid sparing/ multimodal analgesia
PONV Risk stratification
- 1-2 RF - give 2 agents
- Above 2 RF - give 3-4 agents
PONV pharmacological Prophylaxis
- 5HT3 receptor antagonists
- Corticosteroids
- Antihistamines
- Dopamine antagonists
- Propofol anaesthesia
- NK-1 receptor antagonists
- Acupuncture
- Anticholinergics
Non-pharmacological PONV management
In addition to the administration of antiemetics to manage our pt PONV.
- Minimise pt movement and/or avoid rapid movement and ensure analgesia
