Ephedrine for prevention/treatment of PONV?

look for it in obstetrical anesthesia, that is where it is used the most to treat hypotension-induced nausea and vomiting in the pregnant ladies especially during c-section spinal induced hypotension.

I've seen it done in training once. The MDA doing it couldn't give a scientific rationale as to why she thought it worked. I presume it's parasympatheticolytic action may be the rationale. Personally,I don't buy it. There are a number of better drugs with proven efficacy.

" I do remember when Droperidol was the drug of choice, but I haven't seen that in years--thought it was no longer available. "

I'm in Central Ca on the coast and we use droperidol (Inapsine) as well as Anzemet, sometimes Phenergan too. When I was in Portland, Oregon, one year ago, we had not used droperidol in years, usually we used IV phenergan, (or supp) sometimes we used Zofran. some anesthetist's ordered IV Reglan Q 6hr post-op until flatus. Here we don't use phenergan IV ever. So different around the country (world!)

I'm currently doing a study on isopropyl alcohol inhalation for treatment of PONV as my research project for my CRNA program. In our review of the literature the only time I had seen ephedrine used was to treat hypotension-induced PONV. Our study results so far have shown that the most common "uncommon" treatments of PONV are: low-dose propofol, decadron, fluid bolus, scopolamine patches and oxygen therapy.

Yes, stevie I indeed do use ephedrine in certain cases. If you observe post-op patients, you will find that most of them start vomiting when they are moved. I think this is a combination of middle ear issues and postural hypotension. We sit up our patients slowly, watch their BP, give more fluids, If they get nauseated with the sit up and fluids don't take care of the isssue, I lay them down, give ephedrine 25 mg IM, wait for about 15 min and try again. It works like a charm.

My approach to prevention of PONV is a combination of techniques, including getting a good history of prior problems, identifying those in the high risk groups, tailoring my anesthesia for prevention like keeping air out of the stomach, using more local anesthetic in the surgical site than narcotic for post-op pain. I can't remember the last patient who vomited or the last time I gave decadron, zofran or anzemet. Droperidol - NEVER. I do like phenergan in recovery.

Prevention and treatment of PONV is a nursing care issue and all nursing techniques like slow movements, IV fluids, prevention of postural hypotension should be used. I rarely need to use any meds. I noticed the other day zofran had been ordered in January and has never been opened.

I know most of you love to pick up a syringe, but not me. And I have a stack of letters from happy patients who said the anesthetic I gave them was the first one where they didn't get sick.

Sorry for the long answer.
Yoga crna

Please enlighten me...PONV?