Decadron for PONV prophylaxis?

Nitecap · Jan 21, 2006

I have seen the same. I think it is just preference to the clinician ya know, what they feel works for them. Decadron is in most of the PONV literature but there are no recommendations to give it with everycase. As is there no recommendations to even give Zofran with any patient that has no risk though many do. I guess people just do what works for them. Prophal. Zofran seems to be pretty common place though. I have seen as a RN in PACU peeps admin. a nause cocktail of 4mg zofran, 4mg decadron and 6mg phenergan but only to pt's that were actively n/v and retching.

GCShore · Jan 21, 2006

We had a patient today with a significant hx of PONV and she let us know up front that her pain threshold was extremely low. We gave 5 mg Decadron and 0.625 mg Droperidol at the beginning of the procedure, and 1 mg Zofran at the end. We also used low dose Propofol for its antiemetic properties. She did great! My attending stated that for each agent used, it decreased to potential for nausea by say 50%. So basically, the chance of her becoming nauseated should have been around ~6.25%. Her husband was impressed.....said she had always hurled for at least 2 days......

Glad to see that it is not just in my facility that different opinions exist. It makes anesthesia more interesting to shake it up, but it also makes it hard on those of us who are trying to establish protocols/routines. Hang in there......

GCShore

crnabrian · Jan 21, 2006

I give it to most patients, 4mg to most, but if there are indications of PONV likely to occur, 10mg. Along with Zofran. Seems to work for me.

BigDave · Jan 21, 2006

Decadron is only good if given in advance (with induction). Some knifesmiths do not like it for its theoretical impact on wound healing.

Routine use of antiemetics is not warranted in all patients, just in increased risk folks (girls, non-smokers?, hx of PONV, opioid use...and type of surgery: lap gyn, boobs, shoulder, strabismus, etc).

Most researchers in this field (TJ Gan, C Apfel, P Scuderi) speak in terms of number needed to treat (NNT). Most useful agents are 4-5, so out of every 5 people, 1 had a positive effect...20%

Effective tx include: TIVA with propofol, avoid N2O, have good pain control (but don't give too much narcs??). Then the agents: Dec, Zofran and other HT3s, Droperidol (which we can't give any more), maybe Phenergan.

Scop works as well, but needs to be given well in advance.

Some other approaches include: give lots of fluids intraop (maybe good for PONV but bad for other issues?), increased oxygen (studies inconclusive).

BTW, everyone says that Reglan=placebo.

GCShore · Jan 21, 2006

Decadron is only good if given in advance (with induction). Some knifesmiths do not like it for its theoretical impact on wound healing.
Routine use of antiemetics is not warranted in all patients, just in increased risk folks (girls, non-smokers?, hx of PONV, opioid use...and type of surgery: lap gyn, boobs, shoulder, strabismus, etc).
Most researchers in this field (TJ Gan, C Apfel, P Scuderi) speak in terms of number needed to treat (NNT). Most useful agents are 4-5, so out of every 5 people, 1 had a positive effect...20%
Effective tx include: TIVA with propofol, avoid N2O, have good pain control (but don't give too much narcs??). Then the agents: Dec, Zofran and other HT3s, Droperidol (which we can't give any more), maybe Phenergan.
Scop works as well, but needs to be given well in advance.
Some other approaches include: give lots of fluids intraop (maybe good for PONV but bad for other issues?), increased oxygen (studies inconclusive).
BTW, everyone says that Reglan=placebo.

The lady in my case above had a hx of "severe nausea with Scop!" And even though we are not supposed to used Drop anymore......we do in OPD at WFUBMC and guess who my attending was? Phil Scuderi. We did load her up with fluid and we also used nitrous (because she had a hx of waking up slow, so we wanted to decrease the amount of volatile).

BigDave · Jan 21, 2006

PS has an excellent lecture on PONV on Audio-Digest. It's funny that he and TJ are both Carolina settlers.

Droperidol is supposed to be as good or better than anything, and lots of folks think that the "black box" was unwarranted, but if you croak someone with a dysrhythmia you might as well give your house keys to their family.

(BTW SW says hi. He had a nickname for you "Naynay." Do I need to punch him for you?)

GCShore · Jan 21, 2006

PS has an excellent lecture on PONV on Audio-Digest. It's funny that he and TJ are both Carolina settlers.
Droperidol is supposed to be as good or better than anything, and lots of folks think that the "black box" was unwarranted, but if you croak someone with a dysrhythmia you might as well give your house keys to their family.
(BTW SW says hi. He had a nickname for you "Naynay." Do I need to punch him for you?)

:rotfl: No, just blow him a kiss! :rotfl:

athomas91 · Jan 22, 2006

8 of decadron is a heck of a lot less expensive than the zofran..... i am a puker - so i give them all because i wouldn't wish it on any of my patients...

apaisRN, RN, CRNA · Jan 22, 2006

I'm a puker too, when I'm practicing independently my patients will probably get overzealous PONV prophylaxis. My personal experience is that scop made my motion sickness markedly worse and added some dizziness/lack of proprioception. Don't even come near me with that stuff again. I will love phenergan forever despite its' downfalls because it saved me the night I came to the ER in an agony of foodborne illness. And as a bedside nurse, Zofran never seemed to be all that useful.

It will be interesting to learn new perspectives on PONV and the various drugs. All I ask is that a sympathetic CRNA listens to my history if I have to have surgery!

deepz · Jan 23, 2006

........My personal experience is that scop made my motion sickness markedly worse and added some dizziness/lack of proprioception. Don't even come near me with that stuff again........

Curious ... was that scop you received IV or the TransDerm patch? I've put the patch on hundreds of folks without a single complaint of side effects, and good results in synergy with dexamethasone, etc.

?

apaisRN, RN, CRNA · Jan 24, 2006

It was a patch. It wasn't in an anesthesia setting. I was using it for motion sickness. I guess it might not have so much worsened the nausea as affected my balance and perception, and that kind of thing makes me nauseous. The symptoms continued for several hours after I removed the patch.

Maybe if it would have worked better if I'd been supine and receiving anesthesia, instead of sitting in the back seat while my (beloved) father-in-law drove. :rolleyes: