Ephedrine for prevention/treatment of PONV?

[stevierae]

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!

[stevierae]

Update--I found one study, circa 1991. Somehow I don't think interest in using ephedrine for PONV ever caught on, but I could be wrong:

Rothenberg DM, Parnass SM, Litwack K, McCarthy RJ, Newman LM: Efficacy of ephedrine in the prevention of postoperative nausea and vomiting. Anesth Analg 72:58-61, 1991.

This study is the only published controlled study in the current anesthesia literature that assessed the efficacy of ephedrine as an antiemetic. Ephedrine, 0.5 mg/kg IM, was as effective as droperidol, 0.04 mg/kg IM, in preventing postoperative nausea and vomiting. Detailed information is given in the report's introduction and discussion.

[catcolalex]

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.

[gotosleep]

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.

[stevierae]

I asked an anesthesiologist colleague today if he's ever used it as his first-line drug of choice for PONV. Here's his response:

"Nope. Never, never. Ephedrine is used like water, and I mean water for a host of hypotensive events many of which are heralded by vagal like symptomatology in awake patients such as nausea and vomiting.

We treat nausea quickly in OB patients after their epidurals are topped off with ephedrine, for instance; not because it does anything for nausea directly, but, by raising the BP acutely, will restore blood flow to the part of the brain called the "area postrema" which triggers vomiting when it is deprived of oxygen."

[jannrn]

" 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!)

[WVUturtle514]

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.

[yoga crna]

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

[stevierae]

Yoga, I always read your posts attentively, and learn from them. Never apologize--you are a wealth of info and experience.

[CI-PLANTOGAS]

Please enlighten me...PONV?

[AmiK25]

Post-operative nausea and vomiting

[CI-PLANTOGAS]

Post-operative nausea and vomiting

Oh. That was simple.

Thank you.