Need some opinions here, please. Practicing CRNAs:
Which antiemetics do you use ? In combination with? And which ones for which cases? Which cases do you also suggest using Toradol for longer pain mgmt? (we ask the surgeon b4 giving).
As a student, I have begun to use different combinations and have not yet seen consistancy.
I understand that Droperidol is no longer used. My options off hand are: Reglan, Zofran, decadron, Anzemet. Sometimes add benedryl.
Opinion as well as hard facts are welcome. Thanks in advance!
things that cause PONV (both clinical experience and literature-based)
1) letting the patient gag on the ET for too long prior to extubation
2) bolusing larger doses of narcotics (even while asleep it still messes with the brain)
3) while transporting the patient: moving them around quickly, bumping into things, moving backwards, quick spins of the bed, etc...
4) too much inhalational (especially the longer acting ones)
5) nitrous (some think it is due to bowel distention others think it is central)
my treatment includes: zofran, droperidol (FDA allows use if you have pre-op EKG of no long QT and if you monitor for 3 hours - so if you give at beginning of case and case lasts at least 2 hours you won't get funny looks in PACU), reglan, decadron, OGT to decompress the stomach, slow touches of narcotics (mainly use shorter acting and prefer dilaudid/demerol over morphine), benadryl/benzos right after extubation, prefer TIVA over inhaled, and extubation as soon as possible.... not all of these but a customized combination... oh, and if there is blood in the stomach (from oral surgery, what-not) then i also suction the stomach... scopolamine patches are great but really should be applied 3-4 hours prior to insult for decent blood level
somebody mentioned staying away from reversal = i tend to disagree, because neostygmine will assist with GI motility and because glycopyrrolate will clear some secretions.
oh and i also agree with previous post regarding Side effects: all of these drugs do have side effects from mild (headaches for quick pushes of zofran - belly cramps from quick pushes of reglan -burning sensation in groin after quick push of decadron [don't ask me why but i have had that with 7 different patients]) to severe (seizures from reglan) - so drugs should be used wisely
Last edit by Tenesma on Feb 2, '03