Phenergan and HBO treatment..

Specialties CRNA

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Do any of you have any experience in dealing with hyperbaric oxygen (HBO)therapy and the unit refusing to take your post-ops pts that received Phenergan intra-op?

I took care of a young lady that supposedly got PONV after her last surgery approximately one week ago. In examining the old chart, I saw that the PACU RNs gave Phenergan after the onset of N/V. I asked her if she had any episodes after the Phenergan and she said no. There were no further documented doses of Phenergan in the PACU. Her previous anesthetic record showed liberal amounts of hydration and Zofran administration.

Intra-op she recieved again liberal hydration, 4mg Zofran, and 12.5 mg of Phenergan in her IVF bag after induction during my case. Off to PACU we go. PACU RN states that the HOB unit will not take her due to having Phenergan on-board. I realize that Phenergan can lower the seizure threshold, but this young lady had no prior history of any abnormal neurologic activity.

Does the increased oxygen % atmosphere in the HBO place patients at additional risk for onset of seizures? Does phenergan and increased oxygen percentages act in a cumulative fashion for seizures?

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Specializes in I know stuff ;).

did a quick search for you though a journal subsc. There wasent snything there at least.

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did a quick search for you though a journal subsc. There wasent snything there at least.

Thanks for the search. I too am coming up with no answers. Perhaps this is the whim of the medical director for the unit or maybe the nurses on the unit.

Thanks again Mike.

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you think it was the possibility of sedation due to phenergan?

other than that - i can't figure out why..other than the whim you referred to... :)

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you think it was the possibility of sedation due to phenergan?

other than that - i can't figure out why..other than the whim you referred to... :)

No, the PACU RN and I talked for some time about this and he stated the reason that HBO RNs were refusing her was the lowering of the seizure threshold. This was a totally neuro undiagnosed young female. I'm coming up empty in my search.

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Specializes in I know stuff ;).

anytime :)

i have no idea why they would say no other than some random protocol.

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Found the explanation of HBO and seizures.

http://www.emedicine.com/plastic/topic526.htm

Read under "Oxygen Toxicity".

Funny that we were never given a heads up about this at our facility.

I wonder if they won't allow any of the meds that lower seizure thresholds or is phenergan one of the worst ones to have on-board during HBO treatment? Hmmmm..

Will keep you all posted. Going to the unit sometime this week. Maybe I can get a straight answer.

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Found the explanation of HBO and seizures.

http://www.emedicine.com/plastic/topic526.htm

Read under "Oxygen Toxicity".

Funny that we were never given a heads up about this at our facility.

I wonder if they won't allow any of the meds that lower seizure thresholds or is phenergan one of the worst ones to have on-board during HBO treatment? Hmmmm..

Will keep you all posted. Going to the unit sometime this week. Maybe I can get a straight answer.

In that same table, it lists drugs that could be a contraindication to HBO. Phenergan is not listed.

I took a HBO course about 15-20 years ago - that was back when we still used a LOT of phenergan (rarely if ever use it now). I don't remember that being a contraindication back then. Also, oxygen toxicity is a rare thing when standard time/pressure routines are being used.

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In that same table, it lists drugs that could be a contraindication to HBO. Phenergan is not listed.

I took a HBO course about 15-20 years ago - that was back when we still used a LOT of phenergan (rarely if ever use it now). I don't remember that being a contraindication back then. Also, oxygen toxicity is a rare thing when standard time/pressure routines are being used.

I think what they are doing is being conservative in their thinking of:

1. HBO treatment CAN result in a seizure, and

2. Phenergan lowers the seizure threshold

http://www.fda.gov/medwatch/SAFETY/2004/nov_PI/Phenergan_PI.pdf

Short statement under "warnings"

Then coming to the conclusion to avoid the phenergan during HBO therapy. Maybe the unit had a bad experience one time and it is now customary to avoid it.

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Sorry for the random thought pouring-out here. I'm procrastinating somehow linking my project on anesthesia to......a nursing theorist.

I would rather pull my own teeth out with pliars.....

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Specializes in I know stuff ;).

hmm

interesting stuff. You are probably dead on as to why this would be a protocol, some random experience (read: Lawsuit) in the past creates a protocol which is medico-legally protective for the future ;)

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I think what they are doing is being conservative in their thinking of:

1. HBO treatment CAN result in a seizure, and

2. Phenergan lowers the seizure threshold

http://www.fda.gov/medwatch/SAFETY/2004/nov_PI/Phenergan_PI.pdf

Short statement under "warnings"

Then coming to the conclusion to avoid the phenergan during HBO therapy. Maybe the unit had a bad experience one time and it is now customary to avoid it.

I wonder if they limit patients for HBO therapy who dring Coke and coffee, both loaded with caffeine, which of course lowers the seizure threshold, and is often used in ECT's to "enhance" the seizures that are produced.
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