Ephedrine for prevention/treatment of PONV?

yoga crna · Sep 8, 2006

PONV- Post operative nausea vomiting

I usually don't like acronyms, but this one is easier than typing out the entire thing.

y

apaisRN, RN, CRNA · Sep 10, 2006

In my very first rotation a preceptor spoke highly of this technique, although we never used it. I was still pretty overwhelmed with figuring out the bed controls so I don't remember her rationale.

zrmorgan · Sep 11, 2006

We used vistaril/ephedrine IM a lot during GYN cases at my clinical site...I too did not hear much evidence based rationale. Used it a lot for high risk patients (younger women, gyn procedures). I would say it worked, but frequently we did the multi agent thing combining zofran and decadron, so it was difficult to tell which thing was working the best in the 2.5 years I did it. I am using zofran/decadron now and it seems to do the job.

Thanks for the article in a previous post.

macanes, BSN, MSN, DNP, CRNA · Sep 11, 2006

I don't believe I have ever seen Ephedrine ordered or utilized for PONV--not currently; not even in the 90s, '80s, or '70s.
I was looking at a chart for QA purposes, though, in which PACU staff said that 2 doses of Ephedrine given I.V. were for PONV (nothing in anesthesia orders stating reason for order for Ephedrine.) In this situation, Zofran and Reglan were given pre-op, and then again in PACU after 2 hour surgery--but PONV (clear emesis) continued.
I've never seen it used postop for anything but blood pressure support in the event of a vaso-vagal reaction with resultant hypotension, accompanied by bradycardia and hyoxia--or to buy time for a transient profoundly hypotensive episode intra-op while investigating the reason for the crash.
I have, for several years, been seeing more Decadron used as pre-op prophylaxis to prevent PONV, and occasionally Phenergan post-op, but, for the most part, the pre-op prophylaxis regime wherever I have worked is Reglan and Zofran, or Bicitra and Reglan, and they are generally pretty effective. I do remember when Droperidol was the drug of choice, but I haven't seen that in years--thought it was no longer available.
Is anybody here utilizing Ephedrine for PONV? If so, when would it be your drug of choice?
Thanks!

I use ephedrine to treat hypotension . . . which I find is frequently the reason a pt is nauseated, especially on OB and especially during SAB for c/s.

I also use decadron with zofran or anzement (study showed 40% greater efficacy with t&A in kids, as I recall from a few years ago).

I also use zofran or anzement alone.

I also use double dose zofran (8mg) for itching.

I also use droperidol (0.625mg) for n/v as my #1 rescue med when they're already puking.

I rarely use phenergan -- although it's very effective -- only because we don't keep a lot of it around and if you haven't really flushed your line, you'll be changing it.

I violently disagree with those folks who like to post "I NEVER USE . . . " Please. There are 50 ways to do any anesthetic. Try to learn something new every day, yes?

yoga crna · Sep 12, 2006

II violently disagree with those folks who like to post "I NEVER USE . . . " Please. There are 50 ways to do any anesthetic. Try to learn something new every day, yes?

Ok Mac I am guilty of posting that I NEVER use droperidol.

First, please be careful how you state your posts, I have been doing anesthesia for over 46 years and am very current im my techniques and use of agents. You may VIOLENTLY disagree with me and I have the right to VIOLENTLY disagree with your accusation. I was hoping that CRNAs would be more professional than to be so opinionated and not get all of the facts. I stopped posting on here for awhile and am actively involved in the OTHER and BETTER forum, because of that type of attitude from our nursing (non-anesthetists) colleagues.

Second.

Why I NEVER give droperidol

1. It causes dysphoria, even in small doses (check the literature, if you don't believe me). I am in private practice and my patients having a good anesthesia experience is very important.

2. EKG changes with drop (read black box in package insert)

3. Very few of my patients need anything for PONV, because they don't have it.

4. We don't have it in our surgical facility.

I promise to keep an open mind if you also keep one.

sorrento · Sep 13, 2006

I recently did a literaturereview on non-pharmacologic methods of preventing PONV. Acupuncture/Acupressure at Pericardium 6 is a good alternative to antiemetics especially combined with a TIVA (propofol). Has anybody made experience with this procedure?

stevierae · Sep 13, 2006

per yogacrna:

"ekg changes with drop (read black box in package insert")

yes--regarding the black box warning of ekg changes---as soon as that occurred, every place i worked at on the west coast pulled their droperidol out of circulation. i haven't seen it used anywhere since at least the year 2000--possibly earlier. but, i do have a colleague who is an anesthesia provider in manhattan, and he still has access to it, and continues to use it.

athomas91 · Sep 14, 2006

i also had stopped posting here for similar reasons to yoga - however - i did want to comment on this particular thread...

i like droperidol - mostly because it worked for me when i had PONV - but yoga is absolutely right - i was off for over 24 hours due to the dysphoria. droperidol was blackboxed - and is still out of most pharmacys - HOWEVER

it can be used (but the warning labels state) you must use a 5 lead ecg to monitor for QRS changes - so if you are using it w/ a 3 lead or no lead - you are wide open to that lawsuit coming your way.

Zinobile · Sep 14, 2006

Where's the "other, better thread?"

z